Classifications

• • C—CHEMISTRY; METALLURGY
  • C07—ORGANIC CHEMISTRY
  • C07H—SUGARS; DERIVATIVES THEREOF; NUCLEOSIDES; NUCLEOTIDES; NUCLEIC ACIDS
  • C07H21/00—Compounds containing two or more mononucleotide units having separate phosphate or polyphosphate groups linked by saccharide radicals of nucleoside groups, e.g. nucleic acids
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K31/00—Medicinal preparations containing organic active ingredients
  • A61K31/70—Carbohydrates; Sugars; Derivatives thereof
  • A61K31/7084—Compounds having two nucleosides or nucleotides, e.g. nicotinamide-adenine dinucleotide, flavine-adenine dinucleotide
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P31/00—Antiinfectives, i.e. antibiotics, antiseptics, chemotherapeutics
  • A61P31/12—Antivirals
• • C—CHEMISTRY; METALLURGY
  • C07—ORGANIC CHEMISTRY
  • C07H—SUGARS; DERIVATIVES THEREOF; NUCLEOSIDES; NUCLEOTIDES; NUCLEIC ACIDS
  • C07H21/00—Compounds containing two or more mononucleotide units having separate phosphate or polyphosphate groups linked by saccharide radicals of nucleoside groups, e.g. nucleic acids
  • C07H21/04—Compounds containing two or more mononucleotide units having separate phosphate or polyphosphate groups linked by saccharide radicals of nucleoside groups, e.g. nucleic acids with deoxyribosyl as saccharide radical

Definitions

• the present disclosure relates to 2′3′ cyclic di-nucleotides and derivatives thereof that may be useful in the treatments of diseases in which modulation of STING adaptor protein (Stimulator of Interferon Genes) is beneficial, for example, inflammation, allergic and autoimmune diseases, cancer, and viral infections such as chronic hepatitis B and human immunodeficiency virus, and in the preparation of immunogenic compositions or vaccine adjuvants.
• STING adaptor protein Stimulator of Interferon Genes
• the innate immune system recognizes the presence of pathogen or disruption of the homeostasis of the host by a battery of Pattern Recognition Receptors (PRRs) which detect a small set of ligands associated with pathogens or damage. These ligands are generally called Pathogen Associated Molecular Patterns (PAMPs) or Damage Associated Molecular Patterns (DAMPs) (Takeuchi O et al, Cell, 2010:140, 805-820).
• PAMPs Pathogen Associated Molecular Patterns
• DAMPs Damage Associated Molecular Patterns
• PRRs have been identified over past two decades including Toll-like receptors, retinoic acids inducible gene (RIG-I)-like receptors, nucleotide-binding oligomerization domain-like (NOD) receptors, C-type lectin receptor and cytosolic DNA sensors (Brubaker S W et al, Annu Rev Immunol, 2015:33, 257-290). Recognition of PAMPs and DAMPs by PRRs ultimately leads to the upregulation of cytokines and chemokines, including interferons, and recruitment of immune cells to the sites of infection. All of these processes slow down pathogen replication and contribute to the development of adaptive immunity.
• DNA-dependent activator of IRFs DEAD box polypeptide 41
• STING adaptor protein Stimulator Of Interferon Genes, also called STING, STING protein, TMEM173, MITA, or ERIS
• STING adaptor protein Stimulator Of Interferon Genes, also called STING, STING protein, TMEM173, MITA, or ERIS
• NF- ⁇ B nuclear factor kappa B
• IRF-3 interferon regulatory factor 3
• STING adaptor protein can be activated by the second messenger cyclic dinucleotides (CDNs) (Burdette et al. Nature 2011: 478, 515-518).
• CDNs with affinity to STING contain two purine nucleotide monophosphates linked with either two 3′-5′ (3′3′-CDNs), two 2′-5′ (2′2′-CDNs) or 2′-5′ and 3′-5′ phosphodiester bonds (2′3′-CDNs).
• the prototype 2′3′-cGAMP (c[G(2′,5′)pA(3′,5′)p]) is a product of the activation of host cGAS protein in the presence of pathogen or self dsDNA (Zhang et al, Molecular Cell 2013:51, 226-235).
• the type I interferons are immune-regulatory cytokines that play a pivotal role in viral immunity. They can induce dendritic cell (DC) and macrophage maturation and activation (Galluci et al, Nat Med, 1999:5, 1249-1255) and can promote T- and B-cell survival, activation and differentiation. Furthermore, the interferons are capable of activating numerous intracellular pathways that inhibit virus replication. The clinical utility of type I interferons has been demonstrated by their usefulness in treatment of chronic hepatitis B and C (Lin and Young, Cytokine Growth Factor Rev, 2014:25, 369-376).
• interferons have shown utility in treatment of human cancers (Cohen et al, N Engl J Med, 2005:353, 2477-2490, Tsao et al, N Engl J Med, 2004:351, 998-1012). They can inhibit proliferation of tumor cells and may be synergistic with many approved anticancer agents. Furthermore, type-I-IFNs can act on immune cells to induce antitumor response (Musella et al, Oncoimmunology 2017:6:e1314424). Type I IFN signaling was shown to be important in tumor-initiated T cell priming in mice.
• CDNs are believed to promote priming of both cellular and humoral immunity.
• CDNs were shown to be an effective adjuvant in animal models (Dubensky et al, TherAdv Vaccines, 2013:1, 131-143.
• Patent publications WO 2014/093936, WO 2014/189805, WO 2013/185052, US 2014/03441976, WO 2015/077354, WO 2015/185565, WO 2016/145102, WO 2017/093933, WO 2017/027646, WO 2017/027645, WO 2017/175156, WO 2017/175147, WO 2017/123657, WO 2018/013908, WO 2018/013887, WO2018/009652, WO 2018/009648, and WO 2018/009466 disclose certain CDNs and their use in inducing an immune response.
• the present disclosure provides a compound of Formula (I):
• a pharmaceutical composition comprises the cyclic dinucleotide of Formula (I), or an enantiomer, hydrate, solvate or pharmaceutically acceptable salt thereof, and a pharmaceutically acceptable carrier, excipient, and/or diluent.
• a method of treating a disease or disorder comprises administering to a human or animal in need thereof a therapeutically effective amount of a cyclic dinucleotide of Formula (I), or an enantiomer, hydrate, solvate or pharmaceutically acceptable salt thereof, or a pharmaceutical composition of any of the foregoing.
• a method of enhancing the efficacy of a vaccine comprises administering a therapeutically effective amount of a cyclic dinucleotide of Formula (I), or an enantiomer, hydrate, solvate or pharmaceutically acceptable salt thereof, or a pharmaceutical composition of any of the foregoing.
• a method of modulating the activity of STING adaptor protein to induce production of a type I interferon, cytokine and/or chemokine dependent on the STING adaptor protein comprises administering a therapeutically effective amount of a cyclic dinucleotide of Formula (I), or an enantiomer, hydrate, solvate or pharmaceutically acceptable salt thereof, or a pharmaceutical composition of any of the foregoing.
• novel 2′3′-cyclic dinucleotides comprising a phosphonomethoxy group, that bind to and modulate the activity of, e.g., activate, the STING protein.
• Alkyl is a linear or branched saturated monovalent hydrocarbon.
• an alkyl group can have 1 to 10 carbon atoms (i.e., C 1-10 alkyl) or 1 to 8 carbon atoms (i.e., C 1-8 alkyl) or 1 to 6 carbon atoms (i.e., C 1-6 alkyl) or 1 to 4 carbon atoms (i.e., C 1-4 alkyl).
• alkyl groups include, but are not limited to, methyl (Me, —CH 3 ), ethyl (Et, —CH 2 CH 3 ), 1-propyl (n-Pr, n-propyl, —CH 2 CH 2 CH 3 ), 2-propyl (i-Pr, i-propyl, —CH(CH 3 ) 2 ), 1-butyl (n-Bu, n-butyl, —CH 2 CH 2 CH 2 CH 3 ), 2-methyl-1-propyl (i-Bu, i-butyl, —CH 2 CH(CH 3 ) 2 ), 2-butyl (s-Bu, s-butyl, —CH(CH 3 )CH 2 CH 3 ), 2-methyl-2-propyl (t-Bu, t-butyl, —C(CH 3 ) 3 ), 1-pentyl (n-pentyl, —CH 2 CH 2 CH 2 CH 3 ), 2-pentyl (—CH(CH(CH 2
• Alkylene refers to a bivalent linear or branched saturated monovalent hydrocarbon radical derived from an alkane by removal of two hydrogen atoms from different carbon atoms.
• Alkoxy refers to the group —O-alkyl, where alkyl is as defined above.
• C 1-4 alkoxy refers to an —O-alkyl group having 1 to 4 carbons.
• Alkenyl is a linear or branched monovalent hydrocarbon radical with at least one carbon-carbon double bond.
• an alkenyl group can have 2 to 8 carbon atoms (i.e., C 2-8 alkenyl) or 2 to 6 carbon atoms (i.e., C 2-6 alkenyl) or 2 to 4 carbon atoms (i.e., C 2-4 alkenyl).
• alkenyl groups include, but are not limited to, ethenyl (—CH ⁇ CH 2 ), allyl (—CH 2 CH ⁇ CH 2 ), and —CH 2 —CH ⁇ CH—CH 3 .
• Alkenyl groups can be unsubstituted or substituted.
• Alkenylene refers to a bivalent linear or branched monovalent hydrocarbon radical with at least one carbon-carbon double bond derived from an alkene by removal of two hydrogen atoms from different carbon atoms.
• Alkynyl is a linear or branched monovalent hydrocarbon radical with at least one carbon-carbon triple bond.
• an alkynyl group can have 2 to 8 carbon atoms (i.e., C 2-8 alkynyl) or 2 to 6 carbon atoms (i.e., C 2-6 alkynyl) or 2 to 4 carbon atoms (i.e., C 2-4 alkynyl).
• alkynyl groups include, but are not limited to, acetylenyl (—C ⁇ CH), propargyl (—CH 2 C ⁇ CH), and —CH 2 —C ⁇ C—CH 3 .
• Alkynyl groups can be unsubstituted or substituted.
• Alkynylene refers to a bivalent linear or branched monovalent hydrocarbon radical with at least one carbon-carbon triple bond derived from an alkyne by removal of two hydrogen atoms from different carbon atoms.
• Alkylamino is —HNR b group, where R b is an alkyl.
• Alkylthio is —SR b group, where Rb is an alkyl.
• Halo or “halogen” as used herein refers to fluoro (—F), chloro (—Cl), bromo (—Br) and iodo (—I).
• Aryl refers to a single all carbon aromatic ring or a multiple condensed all carbon ring system wherein at least one of the rings is aromatic.
• an aryl group has 6 to 20 carbon atoms, 6 to 14 carbon atoms, 6 to 12 carbon atoms, or 6 to 10 carbon atoms.
• Aryl includes a phenyl radical.
• Aryl also includes multiple condensed ring systems (e.g., ring systems comprising 2, 3 or 4 rings) having about 9 to 20 carbon atoms in which at least one ring is aromatic and wherein the other rings may be aromatic or not aromatic (i.e., carbocycle).
• Such multiple condensed ring systems are optionally substituted with one or more (e.g., 1, 2 or 3) oxo groups on any carbocycle portion of the multiple condensed ring system.
• the rings of the multiple condensed ring system can be connected to each other via fused, spiro and bridged bonds when allowed by valency requirements. It is also to be understood that when reference is made to a certain atom-range membered aryl (e.g., 6-10 membered aryl), the atom range is for the total ring atoms of the aryl.
• a 6-membered aryl would include phenyl and a 10-membered aryl would include naphthyl and 1,2,3,4-tetrahydronaphthyl.
• aryl groups include, but are not limited to, phenyl, indenyl, naphthyl, 1,2,3,4-tetrahydronaphthyl, anthracenyl, and the like.
• Aryl groups can be unsubstituted or substituted.
• “Arylene” as used herein refers to a bivalent radical on a single aromatic ring or multiple condensed all carbon ring system, wherein at least one of the rings is aromatic, formed by removal of two hydrogen atoms from different carbon atoms on the ring or ring system.
• alkylaryl refers to an alkyl as defined herein, wherein one or more hydrogen atoms of the alkyl are independently replaced by an aryl substituent, which may be the same or different.
• the alkyl group and the aryl group can be any of those described above.
• an alkylaryl group has 7 to 24 carbon atoms, 7 to 16 carbon atoms, 7 to 13 carbon atoms, or 7 to 11 carbon atoms.
• An alkylaryl group defined by the number of carbon atoms refers to the total number of carbon atoms present in the constitutive alkyl and aryl groups combined.
• C 7 alkylaryl refers to benzyl
• C 11 alkylaryl includes 1-methylnaphthyl and n-pentylphenyl.
• alkylaryl groups include, but are not limited to, benzyl, 2,2-dimethylphenyl, n-pentylphenyl, 1-methylnaphthyl, 2-ethylnaphthyl, and the like. Alkylaryl groups can be unsubstituted or substituted.
• Alkylarylene refers to a bivalent radical on the group formed from an alkane attached to an aromatic ring, wherein the radical is formed by removal of two hydrogen atoms from each of the alkane and the aromatic ring.
• Heteroaryl refers to a single aromatic ring that has at least one atom other than carbon in the ring, wherein the atom is selected from the group consisting of oxygen, nitrogen and sulfur; “heteroaryl” also includes multiple condensed ring systems that have at least one such aromatic ring, which multiple condensed ring systems are further described below. Thus, “heteroaryl” includes single aromatic rings of from about 1 to 6 carbon atoms and about 1-4 heteroatoms selected from the group consisting of oxygen, nitrogen and sulfur. The sulfur and nitrogen atoms may also be present in an oxidized form provided the ring is aromatic.
• heteroaryl ring systems include but are not limited to pyridyl, pyrimidinyl, oxazolyl or furyl.
• “Heteroaryl” also includes multiple condensed ring systems (e.g., ring systems comprising 2, 3 or 4 rings) wherein a heteroaryl group, as defined above, is condensed with one or more rings selected from heteroaryls (to form for example 1,8-naphthyridinyl), heterocycles, (to form for example 1,2,3,4-tetrahydro-1,8-naphthyridinyl), carbocycles (to form for example 5,6,7,8-tetrahydroquinolyl) and aryls (to form for example indazolyl) to form the multiple condensed ring system.
• heteroaryls to form for example 1,8-naphthyridinyl
• heterocycles to form for example 1,2,3,4-tetrahydro-1,8-naphth
• a heteroaryl (a single aromatic ring or multiple condensed ring system) has about 1-20 carbon atoms and about 1-6 heteroatoms within the heteroaryl ring.
• Such multiple condensed ring systems may be optionally substituted with one or more (e.g., 1, 2, 3 or 4) oxo groups on the carbocycle or heterocycle portions of the condensed ring.
• the rings of the multiple condensed ring system can be connected to each other via fused, spiro and bridged bonds when allowed by valency requirements. It is to be understood that the individual rings of the multiple condensed ring system may be connected in any order relative to one another.
• the point of attachment for a heteroaryl or heteroaryl multiple condensed ring system can be at any suitable atom of the heteroaryl or heteroaryl multiple condensed ring system including a carbon atom and a heteroatom (e.g., a nitrogen).
• a heteroatom e.g., a nitrogen
• the atom range is for the total ring atoms of the heteroaryl and includes carbon atoms and heteroatoms.
• a 5-membered heteroaryl would include a thiazolyl and a 10-membered heteroaryl would include a quinolinyl.
• heteroaryls include but are not limited to pyridyl, pyrrolyl, pyrazinyl, pyrimidinyl, pyridazinyl, pyrazolyl, thienyl, indolyl, imidazolyl, oxazolyl, isoxazolyl, thiazolyl, furyl, oxadiazolyl, thiadiazolyl, quinolyl, isoquinolyl, benzothiazolyl, benzoxazolyl, indazolyl, quinoxalyl, quinazolyl, 5,6,7,8-tetrahydroisoquinolinyl benzofuranyl, benzimidazolyl, thianaphthenyl, pyrrolo[2,3-b]pyridinyl, quinazolinyl-4(3H)-one, and triazolyl. Heteroaryl groups can be unsubstituted or substituted.
• Cycloalkyl refers to a single saturated or partially unsaturated all carbon ring having 3 to 20 annular carbon atoms (i.e., C 3-20 cycloalkyl), for example from 3 to 12 annular atoms, for example from 3 to 10 annular atoms, or 3 to 8 annular atoms, or 3 to 6 annular atoms, or 3 to 5 annular atoms, or 3 to 4 annular atoms.
• the term “cycloalkyl” also includes multiple condensed, saturated and partially unsaturated all carbon ring systems (e.g., ring systems comprising 2, 3 or 4 carbocyclic rings).
• cycloalkyl includes multicyclic carbocyles such as a bicyclic carbocycles (e.g., bicyclic carbocycles having about 6 to 12 annular carbon atoms such as bicyclo[3.1.0]hexane and bicyclo[2.1.1]hexane), and polycyclic carbocycles (e.g tricyclic and tetracyclic carbocycles with up to about 20 annular carbon atoms).
• the rings of a multiple condensed ring system can be connected to each other via fused, spiro and bridged bonds when allowed by valency requirements.
• Non-limiting examples of monocyclic cycloalkyl include cyclopropyl, cyclobutyl, cyclopentyl, 1-cyclopent-1-enyl, 1-cyclopent-2-enyl, 1-cyclopent-3-enyl, cyclohexyl, 1-cyclohex-1-enyl, 1-cyclohex-2-enyl and 1-cyclohex-3-enyl. Cycloalkyl groups can be unsubstituted or substituted.
• Heterocyclyl or “heterocycle” or “heterocycloalkyl” as used herein refers to a single saturated or partially unsaturated non-aromatic ring or a non-aromatic multiple ring system that has at least one heteroatom in the ring (i.e., at least one annular heteroatom selected from oxygen, nitrogen, and sulfur).
• a heterocyclyl group has from 3 to about 20 annular atoms, for example from 3 to 12 annular atoms, for example from 3 to 10 annular atoms, or 3 to 8 annular atoms, or 3 to 6 annular atoms, or 3 to 5 annular atoms, or 4 to 6 annular atoms, or 4 to 5 annular atoms.
• the term includes single saturated or partially unsaturated rings (e.g., 3, 4, 5, 6 or 7-membered rings) having from about 1 to 6 annular carbon atoms and from about 1 to 3 annular heteroatoms selected from the group consisting of oxygen, nitrogen and sulfur in the ring.
• the rings of the multiple condensed ring (e.g. bicyclic heterocyclyl) system can be connected to each other via fused, spiro and bridged bonds when allowed by valency requirements.
• Heterocycles include, but are not limited to, azetidine, aziridine, imidazolidine, morpholine, oxirane (epoxide), oxetane, thietane, piperazine, piperidine, pyrazolidine, piperidine, pyrrolidine, pyrrolidinone, tetrahydrofuran, tetrahydrothiophene, dihydropyridine, tetrahydropyridine, quinuclidine, 2-oxa-6-azaspiro[3.3]heptan-6-yl, 6-oxa-1-azaspiro[3.3]heptan-1-yl, 2-thia-6-azaspiro[3.3]heptan-6-yl, 2,6-diazaspiro[3.3]heptan-2-yl, 2-azabicyclo[3.1.0]hexan-2-yl, 3-azabicyclo[3.1.0]hexanyl, 2-azabicyclo[2.1.1]he
• Oxo refers to ⁇ O.
• Substituted refers to wherein one or more hydrogen atoms of the group are independently replaced by one or more substituents (e.g., 1, 2, 3, or 4 or more) as indicated.
• a “compound of the present disclosure” includes compounds disclosed herein, for example a compound of the present disclosure includes compounds of Formula (I), (Ia), (II), (IIa), (III), (IIIa), (IIIb), (IIIc), (IIId), and/or (IIIe), including the compounds of the Examples.
• Treatment or “treat” or “treating” as used herein refers to an approach for obtaining beneficial or desired results.
• beneficial or desired results include, but are not limited to, alleviation of a symptom and/or diminishment of the extent of a symptom and/or preventing a worsening of a symptom associated with a disease or condition.
• treatment includes one or more of the following: a) inhibiting the disease or condition (e.g., decreasing one or more symptoms resulting from the disease or condition, and/or diminishing the extent of the disease or condition); b) slowing or arresting the development of one or more symptoms associated with the disease or condition (e.g., stabilizing the disease or condition, delaying the worsening or progression of the disease or condition); and c) relieving the disease or condition, e.g., causing the regression of clinical symptoms, ameliorating the disease state, delaying the progression of the disease, increasing the quality of life, and/or prolonging survival.
• inhibiting the disease or condition e.g., decreasing one or more symptoms resulting from the disease or condition, and/or diminishing the extent of the disease or condition
• slowing or arresting the development of one or more symptoms associated with the disease or condition e.g., stabilizing the disease or condition, delaying the worsening or progression of the disease or condition
• relieving the disease or condition e.g., causing the regression of
• Delaying as used herein means to defer, hinder, slow, retard, stabilize and/or postpone development of the disease or condition. This delay can be of varying lengths of time, depending on the history of the disease and/or individual being treated. As is evident to one skilled in the art, a sufficient or significant delay can, in effect, encompass prevention, in that the individual does not develop the disease or condition.
• prevention refers to a regimen that protects against the onset of the disease or disorder such that the clinical symptoms of the disease do not develop.
• prevention relates to administration of a therapy (e.g., administration of a therapeutic substance) to a subject before signs of the disease are detectable in the subject (e.g., administration of a therapeutic substance to a subject in the absence of detectable cancer (e.g., a hepatocellular carcinoma) in the subject).
• the subject may be an individual at risk of developing the disease or disorder, such as an individual who has one or more risk factors known to be associated with development or onset of the disease or disorder.
• the term “preventing a cancer” refers to administering to a subject who does not have a detectable cancer an anti-cancer therapeutic substance. It is understood that the subject for anti-cancer preventative therapy may be an individual at risk of developing cancer. It is also understood that prevention does not require a 100% success rate. In some instances, prevention may be understood as a reduction of the risk of cancer, but not a complete elimination of the occurrence of a cancer.
• the term “preventing HBV infection” refers to administering to a subject who does not have a detectable HBV infection an anti-HBV therapeutic substance. It is understood that the subject for anti-HBV preventative therapy may be an individual at risk of contracting the HBV virus. It is also understood that prevention does not require a 100% success rate. In some instances, prevention may be understood as a reduction of the risk of infection, but not a complete elimination the occurrence of an infection.
• Modulation or “modulating” the activity of a protein refers to alteration of the activity such that the activity increases or decreases. In some embodiments, the modulation increases the activity.
• viral infection describes a diseased state in which a virus invades healthy cells, uses the cell's reproductive machinery to multiply or replicate and ultimately lyse the cell resulting in cell death, release of viral particles and the infection of other cells by the newly produced progeny viruses. Latent infection by certain viruses is also a possible result of viral infection.
• the term “enhancing” refers to any form of increase in the immunogenic activity of an effective dosage of a vaccine as a result of administering to an animal or a human a therapeutically effective dose of a compound of the present disclosure, wherein said compound is administered at any time prior to, simultaneous with, or just after administration to the same animal or human of the effective dosage of a vaccine.
• Animal refers to a non-human mammal, for example, a domestic animal such as a pig, a cow, a horse, a dog, a cat, a rat, or a mouse, or a non-human primate such as a cynomolgus monkey or chimpanzee.
• At risk individual refers to an individual who is at risk of developing a condition to be treated.
• An individual “at risk” may or may not have detectable disease or condition, and may or may not have displayed detectable disease prior to the treatment of methods described herein.
• At risk denotes that an individual has one or more so-called risk factors, which are measurable parameters that correlate with development of a disease or condition and are known in the art. An individual having one or more of these risk factors has a higher probability of developing the disease or condition than an individual without these risk factor(s).
• “Therapeutically effective amount” or “effective amount” as used herein refers to an amount that is effective to elicit the desired biological or medical response, including the amount of a compound that, when administered to a subject for treating a disease, is sufficient to effect such treatment for the disease.
• the effective amount will vary depending on the compound, the disease, and its severity and the age, weight, etc., of the subject to be treated.
• the effective amount can include a range of amounts.
• an effective amount may be in one or more doses, i.e., a single dose or multiple doses may be required to achieve the desired treatment endpoint.
• An effective amount may be considered in the context of administering one or more therapeutic agents, and a single agent may be considered to be given in an effective amount if, in conjunction with one or more other agents, a desirable or beneficial result may be or is achieved.
• Suitable doses of any co-administered compounds may optionally be lowered due to the combined action (e.g., additive or synergistic effects) of the compounds.
• a therapeutically effective amount of a compound provided herein or pharmaceutically acceptable salt thereof may (i) reduce the number of diseased cells; (ii) reduce tumor size; (iii) inhibit, retard, slow to some extent, and preferably stop the diseased cell infiltration into peripheral organs; (iv) inhibit (e.g., slow to some extent and preferably stop) tumor metastasis; (v) inhibit tumor growth; (vi) prevent or delay occurrence and/or recurrence of a tumor; and/or (vii) relieve to some extent one or more of the symptoms associated with cancer or hyperproliferative disease.
• a therapeutically effective amount is sufficient to ameliorate, palliate, lessen, and/or delay one or more of symptoms of cancer or hyperproliferative disease.
• “Pharmaceutically acceptable excipient” includes without limitation any adjuvant, carrier, excipient, glidant, sweetening agent, diluent, preservative, dye/colorant, flavor enhancer, surfactant, wetting agent, dispersing agent, suspending agent, stabilizer, isotonic agent, solvent, or emulsifier which has been approved by the United States Food and Drug Administration as being acceptable for use in humans or domestic animals.
• Co-administration refers to administration of unit dosages of the compounds disclosed herein before or after administration of unit dosages of one or more additional therapeutic agents, for example, administration of the compound disclosed herein within seconds, minutes, or hours of the administration of one or more additional therapeutic agents.
• a unit dose of a compound of the present disclosure is administered first, followed within seconds or minutes by administration of a unit dose of one or more additional therapeutic agents.
• a unit dose of one or more additional therapeutic agents is administered first, followed by administration of a unit dose of a compound of the present disclosure within seconds or minutes.
• a unit dose of a compound of the present disclosure is administered first, followed, after a period of hours (e.g., 1-12 hours), by administration of a unit dose of one or more additional therapeutic agents.
• a unit dose of one or more additional therapeutic agents is administered first, followed, after a period of hours (e.g., 1-12 hours), by administration of a unit dose of a compound of the present disclosure.
• Co-administration of a compound disclosed herein with one or more additional therapeutic agents generally refers to simultaneous or sequential administration of a compound disclosed herein and one or more additional therapeutic agents, such that therapeutically effective amounts of each agent are present in the body of the subject.
• “Pharmaceutically acceptable” or “physiologically acceptable” refer to compounds, salts, compositions, dosage forms and other materials which are useful in preparing a pharmaceutical composition that is suitable for veterinary or human pharmaceutical use.
• the compounds described herein may be prepared and/or formulated as pharmaceutically acceptable salts or when appropriate as a free base.
• Pharmaceutically acceptable salts are non-toxic salts of a free base form of a compound that possesses the desired pharmacological activity of the free base. These salts may be derived from inorganic or organic acids or bases. For example, a compound that contains a basic nitrogen may be prepared as a pharmaceutically acceptable salt by contacting the compound with an inorganic or organic acid.
• Non-limiting examples of pharmaceutically acceptable salts include sulfates, pyrosulfates, bisulfates, sulfites, bisulfites, phosphates, monohydrogen-phosphates, dihydrogenphosphates, metaphosphates, pyrophosphates, chlorides, bromides, iodides, acetates, propionates, decanoates, caprylates, acrylates, formates, isobutyrates, caproates, heptanoates, propiolates, oxalates, malonates, succinates, suberates, sebacates, fumarates, maleates, butyne-1,4-dioates, hexyne-1,6-dioates, benzoates, chlorobenzoates, methylbenzoates, dinitrobenzoates, hydroxybenzoates, methoxybenzoates, phthalates, sulfonates, methylsulfonates, propylsulfonates
• Examples of “pharmaceutically acceptable salts” of the compounds disclosed herein also include salts derived from an appropriate base, such as an alkali metal (for example, sodium, potassium), an alkaline earth metal (for example, magnesium), ammonium and NX 4 + (wherein X is C 1 -C 4 alkyl). Also included are base addition salts, such as sodium or potassium salts.
• an appropriate base such as an alkali metal (for example, sodium, potassium), an alkaline earth metal (for example, magnesium), ammonium and NX 4 + (wherein X is C 1 -C 4 alkyl).
• base addition salts such as sodium or potassium salts.
• n is the number of hydrogen atoms in the molecule.
• the deuterium atom is a non-radioactive isotope of the hydrogen atom.
• Such compounds may increase resistance to metabolism, and thus may be useful for increasing the half-life of the compounds described herein or pharmaceutically acceptable salts, isomer, or a mixture thereof when administered to a mammal. See. e.g., Foster, “Deuterium Isotope Effects in Studies of Drug Metabolism”, Trends Pharmacol. Sci., 5(12):524-527 (1984).
• Such compounds are synthesized by means well known in the art, for example by employing starting materials in which one or more hydrogen atoms have been replaced by deuterium.
• isotopes that can be incorporated into the disclosed compounds also include isotopes of hydrogen, carbon, nitrogen, oxygen, phosphorous, fluorine, chlorine, and iodine, such as 2 H, 3 H, 11 C, 13 C, 14 C, 13 N, 15 N, 15 O, 17 O, 18 O, 31 P, 3 P, 35 S, 18 F, 36 Cl, 123 I, and 125 I, respectively.
• isotopes of hydrogen, carbon, nitrogen, oxygen, phosphorous, fluorine, chlorine, and iodine such as 2 H, 3 H, 11 C, 13 C, 14 C, 13 N, 15 N, 15 O, 17 O, 18 O, 31 P, 3 P, 35 S, 18 F, 36 Cl, 123 I, and 125 I, respectively.
• Substitution with positron emitting isotopes, such as 11 C, 18 F, 15 O and 13 N can be useful in Positron Emission Topography (PET) studies for examining substrate receptor occupancy.
• PET Positron E
• Isotopically-labeled compounds of Formula (I) can generally be prepared by conventional techniques known to those skilled in the art or by processes analogous to those described in the Examples as set out below using an appropriate isotopically-labeled reagent in place of the non-labeled reagent previously employed.
• the compounds of the embodiments disclosed herein, or their pharmaceutically acceptable salts may contain one or more asymmetric centers and may thus give rise to enantiomers, diastereomers, and other stereoisomeric forms that may be defined, in terms of absolute stereochemistry, as (R)- or (S)- or, as (D)- or (L)- for amino acids.
• the present disclosure is meant to include all such possible isomers, as well as their racemic and optically pure forms.
• Optically active (+) and ( ⁇ ), (R)- and (S)-, or (D)- and (L)-isomers may be prepared using chiral synthons or chiral reagents, or resolved using conventional techniques, for example, chromatography and fractional crystallization.
• chirality is not specified but is present, it is understood that the embodiment is directed to either the specific diastereomerically or enantiomerically enriched form; or a racemic or scalemic mixture of such compound(s).
• scalemic mixture is a mixture of stereoisomers at a ratio other than 1:1.
• Stepoisomer refers to a compound made up of the same atoms bonded by the same bonds but having different three-dimensional structures, which are not interchangeable.
• the present disclosure contemplates various stereoisomers and mixtures thereof and includes “enantiomers”, which refers to two stereoisomers whose molecules are non-superimposable mirror images of one another.
• Tautomer refers to a proton shift from one atom of a molecule to another atom of the same molecule.
• the present disclosure includes tautomers of any said compounds.
• Solvate refers to the result of the interaction of a solvent and a compound. Solvates of salts of the compounds described herein are also provided. Hydrates of the compounds described herein are also provided.
• Hydrophilate refers to a compound of the disclosure that is chemically associated with one or more molecules of water.
• Prodrug refers to a derivative of a drug that upon administration to the human body is converted to the parent drug according to some chemical or enzymatic pathway.
• a prodrug is a biologically inactive derivative of a drug that upon administration to the human body is converted to the biologically active parent drug according to some chemical or enzymatic pathway.
• Prodrugs for phosphonate and phosphates are known in the art.
• A, A 1 , A 2 , A 3 and A 4 are each independently H, OH, or NH 2 .
• A is NH 2 .
• a 1 is NH 2 .
• a 2 is NH 2 .
• a 3 is NH 2 .
• a 4 is NH 2 .
• each R 15 is independently H, —C( ⁇ Z 1 )R 16 , —C( ⁇ Z 1 )OR 16 , —C( ⁇ Z 1 )N(R 16 ) 2 , C 1 -C 6 alkyl, C 3 -C 7 cycloalkyl, C 2 -C 10 heterocycloalkyl, C 6 -C 10 aryl, or C 2 -C 10 heteroaryl.
• each R 15 is independently H, C 1 -C 6 alkyl, or C 6 -C 10 aryl.
• each R 16 is independently C 1 -C 6 alkyl.
• Z is O.
• Z 1 is O.
• X 2 and X 4 are each O. In some embodiments, X 2 and X 4 are each S. In some embodiments, X 2 is O, and X 4 is S. In some embodiments, X 2 is S, and X 4 is O.
• the compound of Formula (I) has the structure of Formula (Ia):
• the compound of Formula (I) has the structure of Formula (II):
• the compound of Formula (I), (Ia) and/or (II) has the structure of Formula (IIa):
• Base 1 and Base 2 are each independently:
• Base 1 and Base 2 are each independently:
• Base 1 and Base 2 are each independently:
• Base 1 and Base 2 are each independently
• Base 1 is
• Base 1 is
• Base 1 is
• Base 1 is
• Base 1 and Base 2 are each
• a 1 , A 2 , A 3 and A 4 are each independently H, OH, or NH 2 .
• a 1 is OH or NH 2 .
• a 2 is H or NH 2 .
• a 3 is H or NH 2 .
• a 4 is NH 2 .
• a 1 , A 2 , and A 3 are each independently H, OH, or NH 2 .
• a 1 is OH or NH 2 .
• a 2 is H or NH 2 .
• a 3 is H or NH 2 .
• the compound of Formula (I), (Ia), (II) and/or (IIa) has the structure of Formula (III):
• a 1 is OH or NH 2 ;
• a 2 is H or NH 2 ; and
• a 3 is H.
• X 1 is OH; and X 3 is OR 1 .
• X 1 is OR 1 ; and X 3 is OH.
• X 1 and X 3 are each independently OR 1 .
• X 1 is SR 1 ; and X 3 is OH.
• X 1 is OH; and X 3 is SR 1 .
• X 1 and X 3 are each independently selected from the group consisting of OH and SH, wherein at least one of X 1 and X 3 is SH.
• X 1 is SH; and X 3 is OH. In some embodiments, X 1 is OH; and X 3 is SH. In some embodiments, X 1 is SR 1 ; and X 3 is SH. In some embodiments, X 1 is SH; and X 3 is SR 1 . In some embodiments, X 1 and X 3 are each SH. In some embodiments, X 1 and X 3 are each independently SR 1 .
• each R 1 is independently -L-R 2 .
• L is L 1 , L 1 -O(C ⁇ O)-L 2 , L 1 -(C ⁇ O)O-L 2 , L 1 -O-L 2 , L 1 -O(C ⁇ O)O-L 2 , L 1 -O(C ⁇ O)NR 6 -L 2 , or L 1 -NR 6 (C ⁇ O)O-L 2 .
• L is L 1 , L 1 -O(C ⁇ O)-L 2 , L 1 -(C ⁇ O)O-L 2 , or L 1 -O-L 2 .
• L is L 1 , L 1 -O(C ⁇ O)-L 2 , or L 1 -O-L 2 .
• L 1 is C 1 -C 6 alkylene or C 7 -C 13 alkylarylene. In some embodiments, L 1 is —CH 2 — or —CH 2 -Ph-. In some embodiments, L 1 is —CH 2 —. In some embodiments, L 1 is C 7 -C 13 alkylarylene, such as —CH 2 -Ph-.
• L 2 is C 1 -C 6 alkylene, C 6 -C 10 arylene, or 5- to 10-membered heteroarylene.
• L 2 is C 1 -C 6 alkylene or C 6 -C 10 arylene.
• L 2 can be —CH 2 —.
• L 2 is C 6 -C 10 arylene.
• L 2 can be phenylene.
• L 3 is C 1 -C 6 alkylene, e.g., —CH 2 —.
• R 2 is —O(C ⁇ O)—R 2a or —O(C ⁇ O)—O—R 2a .
• R 2a is C 1 -C 20 alkyl, C 2 -C 20 alkenyl, C 2 -C 20 alkynyl, or —(C 1 -C 6 alkylene)-(C 3 -C 14 cycloalkyl).
• R 2a is C 3 -C 20 cycloalkyl, e.g., C 3 -C 16 cycloalkyl, C 3 -C 10 cycloalkyl, C 3 -C 8 cycloalkyl, C 3 -C 7 cycloalkyl, C 5 -C 8 cycloalkyl, or C 4 -C 7 cycloalkyl.
• R 2a is C 1 -C 20 alkyl or —(C 1 -C 6 alkylene)-(C 3 -C 14 cycloalkyl).
• R 2a is C 1 -C 20 alkyl or —CH 2 —(C 3 -C 14 cycloalkyl). In some embodiments, R 2a is —CH 2 —(C 3 -C 14 cycloalkyl), e.g., —CH 2 —(C 3 -C 10 cycloalkyl), —CH 2 —(C 3 -C 8 cycloalkyl), —CH 2 —(C 3 -C 7 cycloalkyl), or —CH 2 —(C 5 -C 8 cycloalkyl).
• R 2a is C 1 -C 20 alkyl, such as C 1 -C 16 alkyl, C 3 -C 20 alkyl, C 3 -C 18 alkyl, C 3 -C 16 alkyl, C 3 -C 14 alkyl, C 3 -C 12 alkyl, C 3 -C 10 alkyl, C 3 -C 8 alkyl, C 2 -C 8 alkyl, C 1 -C 8 alkyl, C 1 -C 6 alkyl, C 2 -C 6 alkyl, or C 3 -C 6 alkyl.
• X 1 is
• X 1 is
• R 2a is C 3 -C 20 alkyl.
• X 1 is
• R 2a is C 3 -C 20 alkyl.
• X 1 is
• X 1 is
• X 1 is
• X 1 is
• X 1 is
• R 2a is C 3 -C 20 alkyl.
• X 1 is
• X 1 is
• X 1 is
• X 1 is
• X 1 is
• X 3 is
• X 3 is
• R 2a is C 3 -C 20 alkyl.
• X 3 is
• R 2 is C 3 -C 20 alkyl.
• X 3 is
• X 3 is
• X 3 is
• X 3 is
• X 3 is
• R 2a is C 3 -C 20 alkyl.
• X 3 is
• X 1 is
• X 3 is
• X 3 is
• X 3 is
• R 2a is substituted with 1 or 2 R 2b . In some embodiments, R 2a is substituted with one R 2b .
• R 2b is —OH, halogen, —CN, C 1 -C 6 alkoxy, or C 1 -C 6 alkylthio. In some embodiments, R 2b is a halogen, e.g., F or Cl.
• X 1 is OR 1 or SR 1 ;
• R 1 is -L-R 2 ;
• L is L 1 ;
• L 1 is C 1 -C 6 alkylene;
• R 2 is —O(C ⁇ O)—R 2a or —O(C ⁇ O)—O—R 2a ; and
• R 2a is C 1 -C 20 alkyl.
• X 1 is OR 1 or SR 1 ; R 1 is -L-R 2 ; L is —CH 2 —; R 2 is —O(C ⁇ O)—R 2a or —O(C ⁇ O)—O—R 2a ; and R 2a is C 3 -C 20 alkyl.
• X 3 is OR 1 or SR 1 ;
• R 1 is -L-R 2 ;
• L is L 1 ;
• L 1 is C 1 -C 6 alkylene;
• R 2 is —O(C ⁇ O)—R 2a or —O(C ⁇ O)—O—R 2a ; and
• R 2a is C 1 -C 20 alkyl.
• X 3 is OR 1 or SR 1 ; R 1 is -L-R 2 ; L is —CH 2 —; R 2 is —O(C ⁇ O)—R 2a or —O(C ⁇ O)—O—R 2a ; and R 2a is C 3 -C 20 alkyl.
• X 1 is OR 1 or SR 1 ;
• R 1 is -L-R 2 ;
• L is L 1 ;
• L 1 is C 7 -C 13 alkylarylene;
• R 2 is —O(C ⁇ O)—R 2 or —O(C ⁇ O)—O—R 2a ; and
• R 2a is C 1 -C 20 alkyl.
• X 1 is OR 1 or SR 1 ;
• R 1 is -L-R 2 ;
• L is L 1 ;
• L 1 is —CH 2 -Ph-;
• R 2 is —O(C ⁇ O)—R 2a or —O(C ⁇ O)—O—R 2a ; and
• R 2a is C 3 -C 2 alkyl.
• X 3 is OR 1 or SR 1 ;
• R 1 is -L-R 2 ;
• L is L 1 ;
• L 1 is C 7 -C 13 alkylarylene;
• R 2 is —O(C ⁇ O)—R 2a or —O(C ⁇ O)—O—R 2a ; and
• R 2a is C 1 -C 20 alkyl.
• X 3 is OR 1 or SR 1 ; R 1 is -L-R 2 ; L is L 1 ; L 1 is —CH 2 -Ph-; R 2 is —O(C ⁇ O)—R 2a or —O(C ⁇ O)—O—R 2a ; and R 2a is C 3 -C 20 alkyl.
• the compound of Formula (III) has the structure of Formula (IIIa):
• the compound of Formula (III) has the structure of Formula (IIIb):
• the compound of Formula (III) has the structure of Formula (IIIc):
• the compound of Formula (III) has the structure of Formula (IIId):
• a 2 is H. In some embodiments, A 2 is NH 2 .
• R 3 is C 3 -C 20 alkyl or —O—(C 3 -C 20 alkyl). In some embodiments, R 3 is C 1 -C 16 alkyl or —O—(C 1 -C 16 alkyl). In some embodiments, R 3 is C 3 -C 16 alkyl or —O—(C 3 -C 16 alkyl). In some embodiments, R 3 is C 1 -C 6 alkyl or —O—(C 1 -C 6 alkyl). In some embodiments, R 3 is C 1 -C 6 alkyl.
• a 1 is OH. In some embodiments, A 1 is NH 2 .
• a 2 is H and A 1 is NH 2 . In some embodiments, A 2 is NH 2 and A 1 is OH.
• the compound is a compound of Formula (I), (Ia), (II), (ha), (III), (IIIa), (IIIb), (IIIc), and/or (IIId), or a pharmaceutically acceptable salt thereof.
• R 4 and R 10 are each independently H or F. In some embodiments, R 4 and R 10 are each H. In some embodiments, R 4 and R 10 are each F.
• the compound of Formula (III) has the structure of Formula (IIIe):
• a 2 is H. In some embodiments, A 2 is NH 2 .
• R 3 is C 3 -C 20 alkyl or —O—(C 3 -C 20 alkyl). In some embodiments, R 3 is C 1 -C 16 alkyl or —O—(C 1 -C 16 alkyl). In some embodiments, R 3 is C 3 -C 16 alkyl or —O—(C 3 -C 16 alkyl). In some embodiments, R 3 is C 1 -C 6 alkyl or —O—(C 1 -C 6 alkyl). In some embodiments, R 3 is C 1 -C 6 alkyl.
• a 1 is OH. In some embodiments, A 1 is NH 2 .
• a 2 is H and A 1 is NH 2 . In some embodiments, A 2 is NH 2 and A 1 is OH.
• the compound is a compound of Formula (IIIe), or a pharmaceutically acceptable salt thereof.
• R 4 and R 10 are each independently H or F. In some embodiments, R 4 and R 10 are each H. In some embodiments, R 4 and R 10 are each F.
• R 2a is C 2 -C 20 alkyl, e.g., C 2 -C 16 alkyl, C 2 -C 14 alkyl, C 2 -C 12 alkyl, C 2 -C 8 alkyl, C 2 -C 6 alkyl, C 3 -C 16 alkyl, C 3 -C 14 alkyl, C 3 -C 12 alkyl, C 3 -C 8 alkyl, or C 3 -C 6 alkyl.
• the compound of the present disclosure has the structure:
• the compound of the present disclosure has the structure:
• the compound of the present disclosure has the structure:
• a compound of Formula (I), (Ia), (II), (IIa), (III), (IIIa), (IIIb), (IIIc), (IIId), and/or (IIIe), has the structure as depicted or is a tautomer, enantiomer, or pharmaceutically acceptable salt thereof.
• the compound is a compound of Formula (I), (Ia), (II), (IIa), (III), (IIIa), (IIIb), (IIIc), (IIId), and/or (IIIe), or a pharmaceutically acceptable salt thereof.
• a compound of the disclosure e.g, a compound of Formula (I), (Ia), (II), (Ha), (III), (IIIa), (IIIb), (IIIc), (IIId), and/or (IIIe), can be shown in a number of equivalent depictions.
• a compound of Formula (Ia) is typically depicted herein as shown above with the 2′- or 3′-substitution of each nucleoside facing each other:
• the present disclosure provides a pharmaceutical composition
• a compound of the present disclosure e.g. a compound of Formula (I), (Ia), (II), (IIa), (III), (IIIa), (IIIb), (IIIc), (IIId), and/or (IIIe)
• a pharmaceutically acceptable salt thereof e.g. a compound of Formula (I), (Ia), (II), (IIa), (III), (IIIa), (IIIb), (IIIc), (IIId), and/or (IIIe)
• a pharmaceutically acceptable salt thereof e.g. a compound of Formula (I), (Ia), (II), (IIa), (III), (IIIa), (IIIb), (IIIc), (IIId), and/or (IIIe)
• a pharmaceutically acceptable salt thereof e.g. a compound of Formula (I), (Ia), (II), (IIa), (III), (IIIa), (IIIb), (IIIc), (IIId), and/or (IIIe)
• the pharmaceutical composition comprises one or more additional therapeutic agent, as more fully set forth below.
• compositions comprising the compounds disclosed herein, or pharmaceutically acceptable salts thereof, may be prepared with one or more pharmaceutically acceptable excipients which may be selected in accord with ordinary practice. Tablets may contain excipients including glidants, fillers, binders and the like. Aqueous compositions may be prepared in sterile form, and when intended for delivery by other than oral administration generally may be isotonic. All compositions may optionally contain excipients such as those set forth in the Rowe et al, Handbook of Pharmaceutical Excipients, 6 th edition, American Pharmacists Association, 2009.
• Excipients can include ascorbic acid and other antioxidants, chelating agents such as EDTA, carbohydrates such as dextrin, hydroxyalkylcellulose, hydroxyalkylmethylcellulose, stearic acid and the like.
• the composition is provided as a solid dosage form, including a solid oral dosage form.
• compositions include those suitable for various administration routes, including oral administration.
• the compositions may be presented in unit dosage form and may be prepared by any of the methods well known in the art of pharmacy. Such methods include the step of bringing into association the active ingredient (e.g., a compound of the present disclosure or a pharmaceutical salt thereof) with one or more pharmaceutically acceptable excipients.
• the compositions may be prepared by uniformly and intimately bringing into association the active ingredient with liquid excipients or finely divided solid excipients or both, and then, if necessary, shaping the product. Techniques and formulations generally are found in Remington: The Science and Practice of Pharmacy, 21 st Edition, Lippincott Williams and Wilkins, Philadelphia, Pa., 2006.
• compositions described herein that are suitable for oral administration may be presented as discrete units (a unit dosage form) including but not limited to capsules, sachets or tablets each containing a predetermined amount of the active ingredient.
• the pharmaceutical composition is a tablet.
• compositions disclosed herein comprise one or more compounds disclosed herein, or a pharmaceutically acceptable salt thereof, together with a pharmaceutically acceptable excipient and optionally other therapeutic agents.
• Pharmaceutical compositions containing the active ingredient may be in any form suitable for the intended method of administration. When used for oral use for example, tablets, troches, lozenges, aqueous or oil suspensions, dispersible powders or granules, emulsions, hard or soft capsules, syrups or elixirs may be prepared.
• Compositions intended for oral use may be prepared according to any method known to the art for the manufacture of pharmaceutical compositions and such compositions may contain one or more excipients including sweetening agents, flavoring agents, coloring agents and preserving agents, in order to provide a palatable preparation.
• excipients which are suitable for manufacture of tablets are acceptable.
• excipients may be, for example, inert diluents, such as calcium or sodium carbonate, lactose, lactose monohydrate, croscarmellose sodium, povidone, calcium or sodium phosphate; granulating and disintegrating agents, such as maize starch, or alginic acid; binding agents, such as cellulose, microcrystalline cellulose, starch, gelatin or acacia; and lubricating agents, such as magnesium stearate, stearic acid or talc.
• inert diluents such as calcium or sodium carbonate, lactose, lactose monohydrate, croscarmellose sodium, povidone, calcium or sodium phosphate
• granulating and disintegrating agents such as maize starch, or alginic acid
• binding agents such as cellulose, microcrystalline cellulose, starch, gelatin or acacia
• lubricating agents such as magnesium
• Tablets may be uncoated or may be coated by known techniques including microencapsulation to delay disintegration and adsorption in the gastrointestinal tract and thereby provide a sustained action over a longer period.
• a time delay material such as glyceryl monostearate or glyceryl distearate alone or with a wax may be employed.
• a dosage form for oral administration to humans may contain approximately 1 to 1000 mg of active material formulated with an appropriate and convenient amount of a pharmaceutically acceptable excipient.
• the pharmaceutically acceptable excipient varies from about 5 to about 95% of the total compositions (weight:weight).
• compositions comprising a compound of the present disclosure, or a pharmaceutically acceptable salt thereof in one variation does not contain an agent that affects the rate at which the active ingredient is metabolized.
• compositions comprising a compound of the present disclosure in one aspect do not comprise an agent that would affect (e.g., slow, hinder or retard) the metabolism of a compound of the present disclosure or any other active ingredient administered separately, sequentially or simultaneously with a compound of the present disclosure.
• any of the methods, kits, articles of manufacture and the like detailed herein in one aspect do not comprise an agent that would affect (e.g., slow, hinder or retard) the metabolism of a compound of the present disclosure or any other active ingredient administered separately, sequentially or simultaneously with a compound of the present disclosure.
• the disclosure further includes a pharmaceutical composition as described above for use in modulating STING protein activity, to induce STING-dependent production of type I interferons, cytokines or chemokines.
• the disclosure further includes a pharmaceutical composition as described above for use in treating or preventing viral infection, infection caused by hepatitis B virus, by HIV, hyperproliferative disease or cancer.
• compositions described above are for use in a human or an animal.
• the disclosure further includes a compound of the present disclosure for administration as a single active ingredient of a pharmaceutically acceptable composition which can be prepared by conventional methods known in the art, for example by binding the active ingredient to a pharmaceutically acceptable, therapeutically inert organic and/or inorganic carrier or excipient, or by mixing therewith.
• a compound of the present disclosure as a second or other active ingredient having a synergistic effect with other active ingredients in known drugs, or administration of the compound of the present disclosure together with such drugs.
• the compound of the present disclosure may also be used in the form of a prodrug or other suitably modified form which releases the active ingredient in vivo.
• a method of treating a disease or disorder comprising administering to a human or animal in need thereof a therapeutically effective amount of a compound of the present disclosure, including compounds of Formula (I), (Ia), (II), (IIa), (III), (IIIa), (IIIb), (IIIc), (IIId), and/or (IIIe), or an enantiomer, or pharmaceutically acceptable salt thereof.
• the Stimulator of interferon genes (STING) adaptor protein also known as STING, STING protein, transmembrane protein 173 (TMEM173), MPYS, mediator of IRF3 activation (MITA), or endoplasmic reticulum interferon stimulator (ERIS), is a protein that in humans is encoded by the TMEM173 gene (UniProt code Q86WV6; NCBI Reference Sequences: NP_938023.1 (isoform 1) and NP_001288667 (isoform 2)).
• STING adaptor protein is believed to function as both a direct cytosolic DNA sensor (CDS) and an adaptor protein in Type I interferon signaling through different molecular mechanisms.
• STING adaptor protein has been shown to activate downstream transcription factors STAT6 and IRF3 through TBK1, and NF- ⁇ B through IKK ⁇ , which can effect an antiviral response or innate immune response against an intracellular pathogen.
• STING adaptor protein plays a role in innate immunity by inducing type I interferon production when cells are infected with intracellular pathogens, such as viruses, mycobacteria and intracellular parasites.
• Type I interferon mediated by STING adaptor protein, protects infected cells and nearby cells from local infection by autocrine and paracrine signaling.
• a method of preventing or treating a disease or condition responsive to the modulation of STING adaptor protein comprising administering to a human or animal in need thereof a therapeutically effective amount of a cyclic dinucleotide provided herein, including compounds of the present disclosure, or an enantiomer, or pharmaceutically acceptable salt thereof.
• a method of inducing a STING adaptor protein-dependent type I interferon, cytokine or chemokine in a human or animal comprising administering a therapeutically effective amount of a cyclic dinucleotide provided herein, including compounds of the present disclosure, or an enantiomer, or pharmaceutically acceptable salt thereof.
• STING adaptor protein in turn activates protein kinase TBK1, which subsequently activates downstream transcription factors NF- ⁇ B and IRF-3. Activation of STING adaptor protein ultimately is believed to result in the release of type I and III interferons as well as a variety of cytokines and chemokines such as IL-6, TNF- ⁇ and INF- ⁇ . Accordingly, induction of a STING adaptor protein-dependent type I interferon, cytokine or chemokine in a human or animal results in the activation of one or more of NF- ⁇ B, IRF-3, a type I interferon, a type III interferon, IL-6, TNF- ⁇ , and INF- ⁇ in said human or animal.
• a method of treating or preventing viral infection comprising administering to a human or animal in need thereof a therapeutically effective amount of a compound of the present disclosure, or an enantiomer, or pharmaceutically acceptable salt thereof.
• Viral infections that can be treated or prevented by the methods of the present disclosure can be any infection caused by a virus, e.g., a virus from the Hepadnaviridae family of viruses, e.g., hepatitis B; or any retrovirus, e.g., an alpharetrovirus, such as Rous sarcoma virus; a betaretrovirus, such as simian retrovirus; a deltaretrovirus, such as bovine leukemia virus or human T-lymphotrophic virus (HTLV) including HTLV-1, HTLV-2, and HTLV-3; a gammaretrovirus, such as murine leukemia virus or feline leukemia virus; or a lentivirus, such as human immunodeficiency virus (HIV) including HIV-1 and HIV-2, simian immunodeficiency virus, equine infectious anemia virus, bovine immunodeficiency virus, rabbit endogenous lentivirus type K (RELIK), or feline immunodefic
• a method of treating or preventing a hyperproliferative disease or cancer comprising administering to a human or animal in need thereof a therapeutically effective amount of a compound of the present disclosure, or an enantiomer, or pharmaceutically acceptable salt thereof.
• Hyperproliferative diseases include diseases caused by excessive growth of non-cancer cells. Such conditions include but are not limited to psoriasis, actinic keratoses, and seborrheic keratoses, warts, keloids, and eczema.
• the cancer is Burkitt's lymphoma, Hodgkin's lymphoma, non-Hodgkin's lymphoma (NHL), indolent non-Hodgkin's lymphoma (iNHL), refractory iNHL, multiple myeloma (MM), chronic myeloid leukemia (CML), acute lymphocytic leukemia (ALL), B-cell ALL, acute myeloid leukemia (AML), chronic lymphocytic leukemia (CLL), small lymphocytic lymphoma (SLL), myelodysplastic syndrome (MDS), myeloproliferative disease (MPD), mantle cell lymphoma (MCL), follicular lymphoma (FL), Waldestrom's macroglobulinemia (WM), T-cell lymphoma, B-cell lymphoma, diffuse large B-cell lymphoma (DLBCL), or marginal zone lymphoma (MZL).
• NHL chronic myeloid
• the cancer is minimal residual disease (MRD).
• the cancer is selected from Hodgkin's lymphoma, non-Hodgkin's lymphoma (NHL), indolent non-Hodgkin's lymphoma (iNHL), and refractory iNHL.
• the cancer is indolent non-Hodgkin's lymphoma (iNHL).
• the cancer is refractory iNHL.
• the cancer is chronic lymphocytic leukemia (CLL).
• the cancer is diffuse large B-cell lymphoma (DLBCL).
• the cancer is a solid tumor selected from the group consisting of pancreatic cancer; bladder cancer; colorectal cancer; breast cancer, including metastatic breast cancer; prostate cancer, including androgen-dependent and androgen-independent prostate cancer; kidney or renal cancer, including, e.g., metastatic renal cell carcinoma; hepatocellular cancer; lung cancer, including, e.g., non-small cell lung cancer (NSCLC), bronchioloalveolar carcinoma (BAC), and adenocarcinoma of the lung; ovarian cancer, including, e.g., progressive epithelial or primary peritoneal cancer; cervical cancer; gastric cancer; esophageal cancer; head and neck cancer, including, e.g., squamous cell carcinoma of the head and neck; melanoma; neuroendocrine cancer, including metastatic neuroendocrine tumors; brain tumors, including, e.g., glioma, anaplastic oligodendroglioma, adult gli
• the cancer stage includes but is not limited to early, advanced, locally advanced, remission, refractory, reoccurred after remission and progressive.
• any of the methods of treatment provided herein may be used to treat a subject (e.g., human) who has been diagnosed with or is suspected of having cancer.
• a subject refers to a mammal, including, for example, a human.
• the subject may be a human who exhibits one or more symptoms associated with cancer or hyperproliferative disease. In some embodiments, the subject may be a human who exhibits one or more symptoms associated with cancer. In some embodiments, the subject is at an early stage of a cancer. In other embodiments, the subject is at an advanced stage of cancer.
• the subject may be a human who is at risk, or genetically or otherwise predisposed (e.g., risk factor) to developing cancer or hyperproliferative disease who has or has not been diagnosed.
• an “at risk” subject is a subject who is at risk of developing cancer.
• the subject may or may not have detectable disease, and may or may not have displayed detectable disease prior to the treatment methods described herein.
• An at risk subject may have one or more so-called risk factors, which are measurable parameters that correlate with development of cancer, which are described herein.
• a subject having one or more of these risk factors has a higher probability of developing cancer than an individual without these risk factor(s).
• risk factors may include, for example, age, sex, race, diet, history of previous disease, presence of precursor disease, genetic (e.g., hereditary) considerations, and environmental exposure.
• the subjects at risk for cancer include, for example, those having relatives who have experienced the disease, and those whose risk is determined by analysis of genetic or biochemical markers.
• the subject may be a human who is undergoing one or more standard therapies, such as chemotherapy, radiotherapy, immunotherapy, surgery, or any combination thereof. Accordingly, one or more compounds provided herein may be administered before, during, or after administration of chemotherapy, radiotherapy, immunotherapy, surgery or combination thereof.
• the subject may be a human who is (i) substantially refractory to at least one chemotherapy treatment, or (ii) is in relapse after treatment with chemotherapy, or both (i) and (ii). In some embodiments, the subject is refractory to at least two, at least three, or at least four chemotherapy treatments (including standard or experimental chemotherapies).
• a method of enhancing the efficacy of a vaccine comprising administering to a human or animal in need thereof a therapeutically effective amount of a cyclic dinucleotide provided herein, including compounds of the present disclosure, or an enantiomer, or pharmaceutically acceptable salt thereof.
• the disclosure includes a cyclic dinucleotide provided herein, including compounds of the present disclosure, or an enantiomer, or pharmaceutically acceptable salt thereof for use as a medicament in a human or animal.
• the disclosure includes a cyclic dinucleotide provided herein, including compounds of the present disclosure, or an enantiomer, or pharmaceutically acceptable salt thereof for use in treating a disease or disorder in a human or animal.
• the disclosure further includes a cyclic dinucleotide provided herein, including compounds of the present disclosure, or an enantiomer, or pharmaceutically acceptable salt thereof for use in modulating the activity of STING protein.
• the disclosure further includes a cyclic dinucleotide provided herein, including compounds of the present disclosure or an enantiomer, or pharmaceutically acceptable salt thereof for use in the prevention or treatment of a disease or condition in a human or animal responsive to the modulation of the STING protein.
• the disclosure further includes a cyclic dinucleotide provided herein, including compounds of the present disclosure, or an enantiomer, or pharmaceutically acceptable salt thereof alone or in combination with one or more therapeutically active substances, for use in STING dependent induction of a type I interferon, cytokine or chemokine in a human or animal.
• the disclosure further includes a cyclic dinucleotide provided herein, including compounds of the present disclosure, or an enantiomer, or pharmaceutically acceptable salt thereof, alone or in combination with one or more therapeutically active agents for use in the treatment or prevention of viral infection in a human or animal.
• the disclosure further includes a cyclic dinucleotide provided herein, including compounds of the present disclosure, or an enantiomer, or pharmaceutically acceptable salt thereof, alone or in combination with one or more therapeutically active substances, for use in the treatment or prevention of infection caused by hepatitis B virus or HIV in a human or animal.
• the disclosure further includes a cyclic dinucleotide provided herein, including compounds of the present disclosure, or an enantiomer, or pharmaceutically acceptable salt thereof alone or in combination with one or more therapeutically active agents, for use in the treatment or prevention of a hyperproliferative disease or cancer in a human or animal.
• the disclosure further includes a cyclic dinucleotide provided herein, including compounds of the present disclosure, or an enantiomer, or pharmaceutically acceptable salt thereof for use in enhancing vaccine efficacy in a human or animal.
• the disclosure further includes a pharmaceutical composition for use in modulating STING protein activity, to induce STING-dependent production of a type I interferon, cytokine or chemokine in a human or animal.
• the disclosure further includes a pharmaceutical composition for use in treating or preventing viral infection, infection caused by hepatitis B virus, by HIV, hyperproliferative disease or cancer in a human or animal.
• the disclosure further includes the use of a cyclic dinucleotide provided herein, including compounds of the present disclosure, or an enantiomer, or pharmaceutically acceptable salt thereof for the production of a medicament for the treatment or prevention of infection caused by hepatitis B virus, by HIV, of hyperproliferative disease or cancer.
• the compounds of the present disclosure can be administered by any route appropriate to the condition to be treated. Suitable routes include oral, rectal, nasal, topical (including buccal and sublingual), transdermal, vaginal and parenteral (including subcutaneous, intramuscular, intravenous, intradermal, intratumoral, intrathecal and epidural), and the like. It will be appreciated that the preferred route may vary with for example the condition of the recipient.
• An advantage of certain compounds disclosed herein is that they are orally bioavailable and can be dosed orally.
• a compound of the present disclosure may be administered to an individual in accordance with an effective dosing regimen for a desired period of time or duration, such as at least about one month, at least about 2 months, at least about 3 months, at least about 6 months, or at least about 12 months or longer.
• the compound is administered on a daily or intermittent schedule for the duration of the individual's life.
• the dosage or dosing frequency of a compound of the present disclosure may be adjusted over the course of the treatment, based on the judgment of the administering physician.
• the compound may be administered to an individual (e.g., a human) in an effective amount. In certain embodiments, the compound is administered once daily.
• the compound can be administered by any useful route and means, such as by oral or parenteral (e.g., intravenous) administration.
• Therapeutically effective amounts of the compound may include from about 0.00001 mg/kg body weight per day to about 10 mg/kg body weight per day, such as from about 0.0001 mg/kg body weight per day to about 10 mg/kg body weight per day, or such as from about 0.001 mg/kg body weight per day to about 1 mg/kg body weight per day, or such as from about 0.01 mg/kg body weight per day to about 1 mg/kg body weight per day, or such as from about 0.05 mg/kg body weight per day to about 0.5 mg/kg body weight per day, or such as from about 0.3 mg to about 30 mg per day, or such as from about 30 mg to about 300 mg per day.
• a compound of the present disclosure may be combined with one or more additional therapeutic agents in any dosage amount of the compound of the present disclosure (e.g., from 1 mg to 1000 mg of compound).
• Therapeutically effective amounts may include from about 1 mg per dose to about 1000 mg per dose, such as from about 50 mg per dose to about 500 mg per dose, or such as from about 100 mg per dose to about 400 mg per dose, or such as from about 150 mg per dose to about 350 mg per dose, or such as from about 200 mg per dose to about 300 mg per dose.
• Other therapeutically effective amounts of the compound of the present disclosure are about 100, 125, 150, 175, 200, 225, 250, 275, 300, 325, 350, 375, 400, 425, 450, 475, or about 500 mg per dose.
• a single dose can be administered hourly, daily, or weekly. For example, a single dose can be administered once every 1 hour, 2, 3, 4, 6, 8, 12, 16 or once every 24 hours. A single dose can also be administered once every 1 day, 2, 3, 4, 5, 6, or once every 7 days. A single dose can also be administered once every 1 week, 2, 3, or once every 4 weeks. In certain embodiments, a single dose can be administered once every week. A single dose can also be administered once every month.
• Kits that comprise a compound of the present disclosure, or an enantiomer, or pharmaceutically acceptable salt thereof, or a pharmaceutical composition containing any of the above, are also included in the present disclosure.
• kits comprising a compound disclosed herein, or a pharmaceutically acceptable salt thereof, in combination with one or more (e.g., one, two, three, four, one or two, or one to three, or one to four) additional therapeutic agents are provided.
• a method for treating or preventing an infectious disease, a viral infection, hepatitis B infection, HIV infection, cancer, or a hyperproliferative disease in a human having or at risk of having the disease comprising administering to the human a therapeutically effective amount of a compound of the present disclosure, or a pharmaceutically acceptable salt thereof, in combination with a therapeutically effective amount of one or more (e.g., one, two, three, four, one or two, one to three, or one to four) additional therapeutic agents.
• one or more e.g., one, two, three, four, one or two, one to three, or one to four
• a method for treating an infectious disease, a viral infection, hepatitis B infection, HIV infection, cancer, or a hyperproliferative disease in a human having or at risk of having the disease comprising administering to the human a therapeutically effective amount of a compound disclosed herein, or a pharmaceutically acceptable salt thereof, in combination with a therapeutically effective amount of one or more (e.g., one, two, three, four, one or two, one to three, or one to four) additional therapeutic agents.
• a compound disclosed herein, or a pharmaceutically acceptable salt thereof is combined with one, two, three, four, or more additional therapeutic agents. In certain embodiments, a compound disclosed herein, or a pharmaceutically acceptable salt thereof, is combined with two additional therapeutic agents. In other embodiments, a compound disclosed herein, or a pharmaceutically acceptable salt thereof, is combined with three additional therapeutic agents. In further embodiments, a compound disclosed herein, or a pharmaceutically acceptable salt thereof, is combined with four additional therapeutic agents.
• the one, two, three, four, or more additional therapeutic agents can be different therapeutic agents selected from the same class of therapeutic agents, and/or they can be selected from different classes of therapeutic agents.
• a compound disclosed herein is administered with one or more additional therapeutic agents.
• Co-administration of a compound disclosed herein with one or more additional therapeutic agents generally refers to simultaneous or sequential administration of a compound disclosed herein and one or more additional therapeutic agents, such that therapeutically effective amounts of the compound disclosed herein and the one or more additional therapeutic agents are both present in the body of the subject.
• the combination may be administered in two or more administrations.
• Co-administration of a compound disclosed herein with one or more additional therapeutic agents generally refers to simultaneous or sequential administration of a compound disclosed herein and one or more additional therapeutic agents, such that therapeutically effective amounts of each agent are present in the body of the patient.
• a compound as disclosed herein may be combined with one or more (e.g., one, two, three, four, one or two, one to three, or one to four) additional therapeutic agents in any dosage amount of the compound of Formula I (e.g., from 10 mg to 1000 mg of compound).
• one or more e.g., one, two, three, four, one or two, one to three, or one to four
• additional therapeutic agents in any dosage amount of the compound of Formula I (e.g., from 10 mg to 1000 mg of compound).
• Co-administration includes administration of unit dosages of the compounds disclosed herein before or after administration of unit dosages of one or more additional therapeutic agents.
• the compound disclosed herein may be administered within seconds, minutes, or hours of the administration of one or more additional therapeutic agents.
• a unit dose of a compound disclosed herein is administered first, followed within seconds or minutes by administration of a unit dose of one or more additional therapeutic agents.
• a unit dose of one or more additional therapeutic agents is administered first, followed by administration of a unit dose of a compound disclosed herein within seconds or minutes.
• a unit dose of a compound disclosed herein is administered first, followed, after a period of hours (e.g., 1-12 hours), by administration of a unit dose of one or more additional therapeutic agents.
• a unit dose of one or more additional therapeutic agents is administered first, followed, after a period of hours (e.g., 1-12 hours), by administration of a unit dose of a compound disclosed herein.
• a compound disclosed herein is combined with one or more additional therapeutic agents in a unitary dosage form for simultaneous administration to a subject, for example as a solid dosage form for oral administration.
• a compound of the present disclosure is formulated as a tablet, which may optionally contain one or more other compounds useful for treating the disease being treated.
• the tablet can contain another active ingredient for treating a viral disease, e.g., hepatitis B virus or HIV.
• such tablets are suitable for once daily dosing.
• compositions comprising a compound disclosed herein, or a pharmaceutically acceptable salt thereof, in combination with one or more (e.g., one, two, three, one or two, or one to three) additional therapeutic agents, and a pharmaceutically acceptable carrier, diluent, or excipient are provided.
• kits comprising a compound of the present disclosure, or a pharmaceutically acceptable salt thereof, in combination with one or more (e.g., one, two, three, four, one or two, or one to three, or one to four) additional therapeutic agents are provided.
• one or more e.g., one, two, three, four, one or two, or one to three, or one to four
• the compounds described herein may be used or combined with one or more of a antiviral agents including abacavir, aciclovir, adefovir, amantadine, amprenavir, arbidol, atazanavir, artipla, brivudine, cidofovir, combivir, edoxudine, efavirenz, emtricitabine, enfuvirtide, entecavir, fomvirsen, fosamprenavir, foscamet, fosfonet, ganciclovir, gardasil, ibacitabine, immunovir, idoxuridine, imiquimod, indinavir, inosine, integrase inhibitors, interferons, including interferon type III, interferon type II, interferon type I, lamivudine, lopinavir, loviride, MK-0518, maraviroc, moroxydine, nelfinavir,
• a compound disclosed herein, or a pharmaceutically acceptable salt thereof is combined with 5-30 mg tenofovir alafenamide fumarate, tenofovir alafenamide hemifumarate, or tenofovir alafenamide. In certain embodiments, a compound disclosed herein, or a pharmaceutically acceptable salt thereof, is combined with 5-10; 5-15; 5-20; 5-25; 25-30; 20-30; 15-30; or 10-30 mg tenofovir alafenamide fumarate, tenofovir alafenamide hemifumarate, or tenofovir alafenamide.
• a compound disclosed herein, or a pharmaceutically acceptable salt thereof is combined with 10 mg tenofovir alafenamide fumarate, tenofovir alafenamide hemifumarate, or tenofovir alafenamide. In certain embodiments, a compound disclosed herein, or a pharmaceutically acceptable salt thereof, is combined with 25 mg tenofovir alafenamide fumarate, tenofovir alafenamide hemifumarate, or tenofovir alafenamide.
• a compound of the present disclosure may be combined with the agents provided herein in any dosage amount of the compound (e.g., from 50 mg to 500 mg of compound) the same as if each combination of dosages were specifically and individually listed.
• a compound disclosed herein, or a pharmaceutically acceptable salt thereof is combined with 100-400 mg tenofovir disoproxil fumarate, tenofovir disoproxil hemifumarate, or tenofovir disoproxil.
• a compound disclosed herein, or a pharmaceutically acceptable salt thereof is combined with 100-150; 100-200, 100-250; 100-300; 100-350; 150-200; 150-250; 150-300; 150-350; 150-400; 200-250; 200-300; 200-350; 200-400; 250-350; 250-400; 350-400 or 300-400 mg tenofovir disoproxil fumarate, tenofovir disoproxil hemifumarate, or tenofovir disoproxil.
• a compound disclosed herein, or a pharmaceutically acceptable salt thereof is combined with 300 mg tenofovir disoproxil fumarate, tenofovir disoproxil hemifumarate, or tenofovir disoproxil. In certain embodiments, a compound disclosed herein, or a pharmaceutically acceptable salt thereof, is combined with 250 mg tenofovir disoproxil fumarate, tenofovir disoproxil hemifumarate, or tenofovir disoproxil.
• a compound disclosed herein, or a pharmaceutically acceptable salt thereof is combined with 150 mg tenofovir disoproxil fumarate, tenofovir disoproxil hemifumarate, or tenofovir disoproxil.
• a compound as disclosed herein e.g., a compound of Formula (I)
• a method for treating or preventing an HIV infection in a human or animal having or at risk of having the infection comprising administering to the human or animal a therapeutically effective amount of a compound disclosed herein, or a pharmaceutically acceptable salt thereof, in combination with a therapeutically effective amount of one or more (e.g., one, two, three, one or two, or one to three) additional therapeutic agents.
• a therapeutically effective amount of a compound disclosed herein, or a pharmaceutically acceptable salt thereof in combination with a therapeutically effective amount of one or more (e.g., one, two, three, one or two, or one to three) additional therapeutic agents.
• a method for treating an HIV infection in a human or animal having or at risk of having the infection comprising administering to the human or animal a therapeutically effective amount of a compound disclosed herein, or a pharmaceutically acceptable salt thereof, in combination with a therapeutically effective amount of one or more (e.g., one, two, three, one or two, or one to three) additional therapeutic agents.
• a therapeutically effective amount of a compound disclosed herein, or a pharmaceutically acceptable salt thereof in combination with a therapeutically effective amount of one or more (e.g., one, two, three, one or two, or one to three) additional therapeutic agents.
• the present disclosure provides a method for treating an HIV infection, comprising administering to a subject in need thereof a therapeutically effective amount of a compound disclosed herein, or a pharmaceutically acceptable salt thereof, in combination with a therapeutically effective amount of one or more additional therapeutic agents which are suitable for treating an HIV infection.
• the compounds disclosed herein are formulated as a tablet, which may optionally contain one or more other compounds useful for treating HIV.
• the tablet can contain another active ingredient for treating HIV, such as HIV protease inhibitors, HIV non-nucleoside or non-nucleotide inhibitors of reverse transcriptase, HIV nucleoside or nucleotide inhibitors of reverse transcriptase, HIV integrase inhibitors, HIV non-catalytic site (or allosteric) integrase inhibitors, pharmacokinetic enhancers, and combinations thereof.
• such tablets are suitable for once daily dosing.
• the additional therapeutic agent may be an anti-HIV agent.
• the additional therapeutic agent is selected from the group consisting of HIV combination drugs, HIV protease inhibitors, HIV non-nucleoside or non-nucleotide inhibitors of reverse transcriptase, HIV nucleoside or nucleotide inhibitors of reverse transcriptase, HIV integrase inhibitors, HIV non-catalytic site (or allosteric) integrase inhibitors, HIV entry inhibitors, HIV maturation inhibitors, immunomodulators, immunotherapeutic agents, antibody-drug conjugates, gene modifiers, gene editors (such as CRISPR/Cas9, zinc finger nucleases, homing nucleases, synthetic nucleases, TALENs), cell therapies (such as chimeric antigen receptor T-cell, CAR-T, and engineered T cell receptors, TCR-T), latency reversing agents, compounds that target the HIV capsid (including capsid inhibitors), immune-
• HIV combination drugs such as HIV
• the additional therapeutic agent is selected from the group consisting of combination drugs for HIV, other drugs for treating HIV, HIV protease inhibitors, HIV reverse transcriptase inhibitors, HIV integrase inhibitors, HIV non-catalytic site (or allosteric) integrase inhibitors, HIV entry (fusion) inhibitors, HIV maturation inhibitors, latency reversing agents, capsid inhibitors, immune-based therapies, PI3K inhibitors, HIV antibodies, and bispecific antibodies, and “antibody-like” therapeutic proteins, and combinations thereof.
• combination drugs include ATRIPLA® (efavirenz, tenofovir disoproxil fumarate, and emtricitabine); COMPLERA® (EVIPLERA®; rilpivirine, tenofovir disoproxil fumarate, and emtricitabine); STRIBILD® (elvitegravir, cobicistat, tenofovir disoproxil fumarate, and emtricitabine); TRUVADA® (tenofovir disoproxil fumarate and emtricitabine; TDF+FTC); DESCOVY® (tenofovir alafenamide and emtricitabine); ODEFSEY® (tenofovir alafenamide, emtricitabine, and rilpivirine); GENVOYA® (tenofovir alafenamide, emtricitabine, cobicistat, and elvitegravir); BIKTARVY® (bictegrace
• HIV protease inhibitors examples include amprenavir, atazanavir, brecanavir, darunavir, fosamprenavir, fosamprenavir calcium, indinavir, indinavir sulfate, lopinavir, nelfinavir, nelfinavir mesylate, ritonavir, saquinavir, saquinavir mesylate, tipranavir, DG-17, TMB-657 (PPL-100), T-169, BL-008, and TMC-310911.
• HIV non-nucleoside or non-nucleotide inhibitors of reverse transcriptase include dapivirine, delavirdine, delavirdine mesylate, doravirine, efavirenz, etravirine, lentinan, nevirapine, rilpivirine, ACC-007, AIC-292, KM-023, PC-1005, and VM-1500.
• HIV nucleoside or nucleotide inhibitors of reverse transcriptase examples include adefovir, adefovir dipivoxil, azvudine, emtricitabine, tenofovir, tenofovir alafenamide, tenofovir alafenamide fumarate, tenofovir alafenamide hemifumarate, tenofovir disoproxil, tenofovir disoproxil fumarate, tenofovir disoproxil hemifumarate, VIDEX® and VIDEX EC® (didanosine, ddl), abacavir, abacavir sulfate, alovudine, apricitabine, censavudine, didanosine, elvucitabine, festinavir, fosalvudine tidoxil, CMX-157, dapivirine, doravirine, etravir
• HIV integrase inhibitors examples include elvitegravir, curcumin, derivatives of curcumin, chicoric acid, derivatives of chicoric acid, 3,5-dicaffeoylquinic acid, derivatives of 3,5-dicaffeoylquinic acid, aurintricarboxylic acid, derivatives of aurintricarboxylic acid, caffeic acid phenethyl ester, derivatives of caffeic acid phenethyl ester, tyrphostin, derivatives of tyrphostin, quercetin, derivatives of quercetin, raltegravir, dolutegravir, JTK-351, bictegravir, AVX-15567, cabotegravir (long-acting injectable), diketo quinolin-4-1 derivatives, integrase-LEDGF inhibitor, ledgins, M-522, M-532, NSC-310217, NSC-371056, NSC-48240, NSC-642710
• NICKI HIV non-catalytic site, or allosteric, integrase inhibitors
• HIV entry (fusion) inhibitors examples include cenicriviroc, CCR5 inhibitors, gp41 inhibitors, CD4 attachment inhibitors, gp120 inhibitors, and CXCR4 inhibitors.
• CCR5 inhibitors examples include aplaviroc, vicriviroc, maraviroc, cenicriviroc, PRO-140, adaptavir (RAP-101), nifeviroc (TD-0232), anti-GP120/CD4 or CCR5 bispecific antibodies, B-07, MB-66, polypeptide C25P, TD-0680, and vMIP (Haimipu).
• gp41 inhibitors examples include albuvirtide, enfuvirtide, BMS-986197, enfuvirtide biobetter, enfuvirtide biosimilar, HIV-1 fusion inhibitors (P26-Bapc), ITV-1, ITV-2, ITV-3, ITV-4, PIE-12 trimer and sifuvirtide.
• CD4 attachment inhibitors examples include ibalizumab and CADA analogs
• gp120 inhibitors examples include Radha-108 (receptol) 3B3-PE38, BanLec, bentonite-based nanomedicine, fostemsavir tromethamine, IQP-0831, and BMS-663068.
• CXCR4 inhibitors examples include plerixafor, ALT-1188, N15 peptide, and vMIP (Haimipu).
• HIV maturation inhibitors examples include BMS-955176 and GSK-2838232.
• latency reversing agents examples include histone deacetylase (HDAC) inhibitors, proteasome inhibitors such as velcade, protein kinase C (PKC) activators, Smyd2 inhibitors, BET-bromodomain 4 (BRD4) inhibitors, ionomycin, PMA, SAHA (suberanilohydroxamic acid, or suberoyl, anilide, and hydroxamic acid), AM-0015, ALT-803, NIZ-985, NKTR-255, IL-15 modulating antibodies, JQ1, disulfiram, amphotericin B, and ubiquitin inhibitors such as largazole analogs, and GSK-343.
• HDAC histone deacetylase
• proteasome inhibitors such as velcade
• PKC protein kinase C
• Smyd2 inhibitors Smyd2 inhibitors
• BET-bromodomain 4 (BRD4) inhibitors ionomycin
• PMA protein kinase
• HDAC inhibitors examples include romidepsin, vorinostat, and panobinostat.
• PKC activators examples include indolactam, prostratin, ingenol B, and DAG-lactones.
• capsid inhibitors include capsid polymerization inhibitors or capsid disrupting compounds, HIV nucleocapsid p7 (NCp7) inhibitors such as azodicarbonamide, HIV p24 capsid protein inhibitors, AVI-621, AVI-101, AVI-201, AVI-301, and AVI-CAN1-15 series;
• NCp7 HIV nucleocapsid p7
• immune-based therapies include toll-like receptors modulators such as TLR1, TLR2, TLR3, TLR4, TLR5, TLR6, TLR7, TLR8, TLR9, TLR10, TLR11, TLR12, and TLR13; programmed cell death protein 1 (Pd-1) modulators; programmed death-ligand 1 (Pd-L1) modulators; IL-15 modulators; DermaVir; interleukin-7; plaquenil (hydroxychloroquine); proleukin (aldesleukin, IL-2); interferon alfa; interferon alfa-2b; interferon alfa-n3; pegylated interferon alfa; interferon gamma; hydroxyurea; mycophenolate mofetil (MPA) and its ester derivative mycophenolate mofetil (MMF); ribavirin; rintatolimod, polymer polyethyleneimine (PEI); gepon; rintatolimod; IL-12; WF-10;
• TLR8 modulators include motolimod, resiquimod, 3M-051, 3M-052, MCT-465, IMO-4200, VTX-763, VTX-1463 and those disclosed in US20140045849 (Janssen), US20140073642 (Janssen), WO2014/056953 (Janssen), WO2014/076221 (Janssen), WO2014/128189 (Janssen), US20140350031 (Janssen), WO2014/023813 (Janssen), US20080234251 (Array Biopharma), US20080306050 (Array Biopharma), US20100029585 (Ventirx Pharma), US20110092485 (Ventirx Pharma), US20110118235 (Ventirx Pharma), US20120082658 (Ventirx Pharma), US20120219615 (Ventirx Pharma), US20140066432 (Ventirx Pharma), US20140088085 (VentirxPharma), US201402
• PI3K inhibitors include idelalisib, alpelisib, buparlisib, CAI orotate, copanlisib, duvelisib, gedatolisib, neratinib, panulisib, perifosine, pictilisib, pilaralisib, puquitinib mesylate, rigosertib, rigosertib sodium, sonolisib, taselisib, AMG-319, AZD-8186, BAY-1082439, CLR-1401, CLR-457, CUDC-907, DS-7423, EN-3342, GSK-2126458, GSK-2269577, GSK-2636771, INCB-040093, LY-3023414, MLN-1117, PQR-309, RG-7666, RP-6530, RV-1729, SAR-245409, SAR-260301, SF-1126
• Integrin alpha-4/beta-7 antagonists include PTG-100, TRK-170, abrilumab, etrolizumab, carotegrast methyl, and vedolizumab.
• HIV antibodies, bispecific antibodies, and “antibody-like” therapeutic proteins include DARTs®, DUOBODIES®, BITES®, XmAbs®, TandAbs®, Fab derivatives, bnABs (broadly neutralizing HIV-1 antibodies), BMS-936559, TMB-360, and those targeting HIV gp120 or gp41, antibody-Recruiting Molecules targeting HIV, anti-CD63 monoclonal antibodies, anti-GB virus C antibodies, anti-GP120/CD4, CCR5 bispecific antibodies, anti-nef single domain antibodies, anti-Rev antibody, camelid derived anti-CD18 antibodies, camelid-derived anti-ICAM-1 antibodies, DCVax-001, gp140 targeted antibodies, gp41-based HIV therapeutic antibodies, human recombinant mAbs (PGT-121), ibalizumab, Immuglo, and MB-66.
• Examples of those targeting HIV in such a manner include bavituximab, UB-421, C2F5, 2G12, C4E10, C2F5+C2G12+C4E10, 8ANC195, 3BNC117, 3BNC60, 10-1074, PGT145, PGT121, PGT-151, PGT-133, MDXO10 (ipilimumab), DH511, N6, VRCO1 PGDM1400, A32, 7B2, 10E8, 10E8v4, CAP256-VRC26.25, DRVIA7, VRC-07-523, VRC-HIVMAB080-00-AB, VRC-HIVMAB060-00-AB, MGD-014 and VRC07.
• Example of HIV bispecific antibodies include MGD014.
• Examples of pharmacokinetic enhancers include cobicistat and ritonavir.
• HIV vaccines include peptide vaccines, recombinant subunit protein vaccines, live vector vaccines, DNA vaccines, CD4-derived peptide vaccines, vaccine combinations, rgp120 (AIDSVAX), ALVAC HIV (vCP1521)/AIDSVAX B/E (gp120) (RV144), monomeric gp120 HIV-1 subtype C vaccine, Remune, ITV-1, Contre Vir, Ad5-ENVA-48, DCVax-001 (CDX-2401), Vacc-4x, Vacc-C5, VAC-3S, multiclade DNA recombinant adenovirus-5 (rAd5), Pennvax-G, Pennvax-GP, HIV-TriMix-mRNA vaccine, HIV-LAMP-vax, Ad35, Ad35-GRIN, NAcGM3NSSP ISA-51, poly-ICLC adjuvanted vaccines, TatImmune, GTU-multiHIV (FIT-06), gp140[delta]V2.TV1+MF-59
• HIV therapeutic agents examples include the compounds disclosed in WO 2004/096286 (Gilead Sciences), WO 2006/015261 (Gilead Sciences), WO 2006/110157 (Gilead Sciences), WO 2012/003497 (Gilead Sciences), WO 2012/003498 (Gilead Sciences), WO 2012/145728 (Gilead Sciences), WO 2013/006738 (Gilead Sciences), WO 2013/159064 (Gilead Sciences), WO 2014/100323 (Gilead Sciences), US 2013/0165489 (University of Pennsylvania), US 2014/0221378 (Japan Tobacco), US 2014/0221380 (Japan Tobacco), WO 2009/062285 (Boehringer Ingelheim), WO 2010/130034 (Boehringer Ingelheim), WO 2013/006792 (Pharma Resources), US 20140221356 (Gilead Sciences), US 20100143301 (Gilead Sciences) and WO 2013/091096 (B
• Examples of other drugs for treating HIV include acemannan, alisporivir, BanLec, deferiprone, Gamimune, metenkefalin, naltrexone, Prolastin, REP 9, RPI-MN, VSSP, Hlviral, SB-728-T, 1,5-dicaffeoylquinic acid, rHIV7-shl-TAR-CCR5RZ, AAV-eCD4-Ig gene therapy, MazF gene therapy, BlockAide, ABX-464, AG-1105, APH-0812, BIT-225, CYT-107, HGTV-43, HPH-116, HS-10234, IMO-3100, IND-02, MK-1376, MK-8507, MK-8591, NOV-205, PA-1050040 (PA-040), PGN-007, SCY-635, SB-9200, SCB-719, TR-452, TEV-90110, TEV-90112, TEV-90111, TEV-
• Gene Therapy and Cell Therapy include the genetic modification to silence a gene; genetic approaches to directly kill the infected cells; the infusion of immune cells designed to replace most of the subject's own immune system to enhance the immune response to infected cells, or activate the subject's own immune system to kill infected cells, or find and kill the infected cells; genetic approaches to modify cellular activity to further alter endogenous immune responsiveness against the infection.
• Examples of dendritic cell therapy include AGS-004.
• gene editing systems include a CRISPR/Cas9 system, a zinc finger nuclease system, a TALEN system, a homing endonucleases system, and a meganuclease system.
• HIV targeting CRISPR/Cas9 systems examples include EBT101.
• CAR-T cell therapy includes a population of immune effector cells engineered to express a chimeric antigen receptor (CAR), wherein the CAR comprises an HIV antigen-binding domain.
• the HIV antigen include an HIV envelope protein or a portion thereof, gp120 or a portion thereof, a CD4 binding site on gp120, the CD4-induced binding site on gp120, N glycan on gp120, the V2 of gp120, the membrane proximal region on gp41.
• the immune effector cell is a T cell or an NK cell. In some embodiments, the T cell is a CD4+ T cell, a CD8+ T cell, or a combination thereof.
• HIV CAR-T examples include VC-CAR-T.
• TCR-T cell therapy includes T cells engineered to target HIV derived peptides present on the surface of virus-infected cells.
• a compound disclosed herein, or a pharmaceutically acceptable salt thereof is combined with an HIV nucleoside or nucleotide inhibitor of reverse transcriptase and an HIV non-nucleoside inhibitor of reverse transcriptase.
• a compound disclosed herein, or a pharmaceutically acceptable salt thereof is combined with an HIV nucleoside or nucleotide inhibitor of reverse transcriptase, and an HIV protease inhibiting compound.
• a compound disclosed herein, or a pharmaceutically acceptable salt thereof is combined with an HIV nucleoside or nucleotide inhibitor of reverse transcriptase, an HIV non-nucleoside inhibitor of reverse transcriptase, and a pharmacokinetic enhancer.
• a compound disclosed herein, or a pharmaceutically acceptable salt thereof is combined with at least one HIV nucleoside inhibitor of reverse transcriptase, an integrase inhibitor, and a pharmacokinetic enhancer.
• a compound disclosed herein, or a pharmaceutically acceptable salt thereof is combined with two HIV nucleoside or nucleotide inhibitors of reverse transcriptase.
• a compound disclosed herein, or a pharmaceutically acceptable salt thereof is combined with one, two, three, four or more additional therapeutic agents selected from ATRIPLA® (efavirenz, tenofovir disoproxil fumarate, and emtricitabine); COMPLERA® (EVIPLERA®; rilpivirine, tenofovir disoproxil fumarate, and emtricitabine); STRIBILD® (elvitegravir, cobicistat, tenofovir disoproxil fumarate, and emtricitabine); TRUVADA® (tenofovir disoproxil fumarate and emtricitabine; TDF+FTC); DESCOVY® (tenofovir alafenamide and emtricitabine); ODEFSEY® (tenofovir alafenamide, emtricitabine, and rilpivirine); GENVOYA® (tenofovir alafenamide,
• a compound disclosed herein, or a pharmaceutically acceptable salt thereof is combined with abacavir sulfate, tenofovir, tenofovir disoproxil, tenofovir disoproxil fumarate, tenofovir disoproxil hemifumarate, tenofovir alafenamide, tenofovir alafenamide hemifumarate, or bictegravir.
• a compound disclosed herein, or a pharmaceutically acceptable salt thereof is combined with tenofovir, tenofovir disoproxil, tenofovir disoproxil fumarate, tenofovir alafenamide, tenofovir alafenamide hemifumarate, or bictegravir.
• a compound disclosed herein, or a pharmaceutically acceptable salt thereof is combined with a first additional therapeutic agent selected from the group consisting of abacavir sulfate, tenofovir, tenofovir disoproxil, tenofovir disoproxil fumarate, tenofovir alafenamide, tenofovir alafenamide hemifumarate, and bictegravir and a second additional therapeutic agent selected from the group consisting of emtricitabine and lamivudine.
• a first additional therapeutic agent selected from the group consisting of abacavir sulfate, tenofovir, tenofovir disoproxil, tenofovir disoproxil fumarate, tenofovir alafenamide, tenofovir alafenamide hemifumarate, and bictegravir
• a second additional therapeutic agent selected from the group consisting of emtricitabine and lamivudi
• a compound disclosed herein, or a pharmaceutically acceptable salt thereof is combined with a first additional therapeutic agent selected from the group consisting of tenofovir, tenofovir disoproxil, tenofovir disoproxil fumarate, tenofovir alafenamide, tenofovir alafenamide hemifumarate, and bictegravir and a second additional therapeutic agent, wherein the second additional therapeutic agent is emtricitabine.
• a compound disclosed herein, or a pharmaceutically acceptable salt thereof is combined with 5-30 mg tenofovir alafenamide fumarate, tenofovir alafenamide hemifumarate, or tenofovir alafenamide, and 200 mg emtricitabine.
• a compound disclosed herein, or a pharmaceutically acceptable salt thereof is combined with 5-10, 5-15, 5-20, 5-25, 25-30, 20-30, 15-30, or 10-30 mg tenofovir alafenamide fumarate, tenofovir alafenamide hemifumarate, or tenofovir alafenamide, and 200 mg emtricitabine.
• a compound disclosed herein, or a pharmaceutically acceptable salt thereof is combined with 10 mg tenofovir alafenamide fumarate, tenofovir alafenamide hemifumarate, or tenofovir alafenamide, and 200 mg emtricitabine. In certain embodiments, a compound disclosed herein, or a pharmaceutically acceptable salt thereof, is combined with 25 mg tenofovir alafenamide fumarate, tenofovir alafenamide hemifumarate, or tenofovir alafenamide, and 200 mg emtricitabine.
• a compound as disclosed herein may be combined with the agents provided herein in any dosage amount of the compound (e.g., from 1 mg to 500 mg of compound) the same as if each combination of dosages were specifically and individually listed.
• a compound disclosed herein, or a pharmaceutically acceptable salt thereof is combined with 200-400 mg tenofovir disoproxil fumarate, tenofovir disoproxil hemifumarate, or tenofovir disoproxil, and 200 mg emtricitabine.
• a compound disclosed herein, or a pharmaceutically acceptable salt thereof is combined with 200-250, 200-300, 200-350, 250-350, 250-400, 350-400, 300-400, or 250-400 mg tenofovir disoproxil fumarate, tenofovir disoproxil hemifumarate, or tenofovir disoproxil, and 200 mg emtricitabine.
• a compound disclosed herein, or a pharmaceutically acceptable salt thereof is combined with 300 mg tenofovir disoproxil fumarate, tenofovir disoproxil hemifumarate, or tenofovir disoproxil, and 200 mg emtricitabine.
• a compound of the present disclosure may be combined with the agents provided herein in any dosage amount of the compound (e.g., from 1 mg to 500 mg of compound) the same as if each combination of dosages were specifically and individually listed.
• a method for treating or preventing an HBV infection in a human having or at risk of having the infection comprising administering to the human a therapeutically effective amount of a compound disclosed herein, or a pharmaceutically acceptable salt thereof, in combination with a therapeutically effective amount of one or more (e.g., one, two, three, four, one or two, one to three, or one to four) additional therapeutic agents.
• a therapeutically effective amount of a compound disclosed herein, or a pharmaceutically acceptable salt thereof in combination with a therapeutically effective amount of one or more (e.g., one, two, three, four, one or two, one to three, or one to four) additional therapeutic agents.
• a method for treating an HBV infection in a human having or at risk of having the infection comprising administering to the human a therapeutically effective amount of a compound disclosed herein, or a pharmaceutically acceptable salt thereof, in combination with a therapeutically effective amount of one or more (e.g., one, two, three, four, one or two, one to three, or one to four) additional therapeutic agents.
• a therapeutically effective amount of a compound disclosed herein, or a pharmaceutically acceptable salt thereof in combination with a therapeutically effective amount of one or more (e.g., one, two, three, four, one or two, one to three, or one to four) additional therapeutic agents.
• the present disclosure provides a method for treating an HBV infection, comprising administering to a patient in need thereof a therapeutically effective amount of a compound disclosed herein or a pharmaceutically acceptable salt thereof, in combination with a therapeutically effective amount of one or more (e.g., one, two, three, four, one or two, one to three, or one to four) additional therapeutic agents which are suitable for treating an HBV infection.
• a therapeutically effective amount of a compound disclosed herein or a pharmaceutically acceptable salt thereof in combination with a therapeutically effective amount of one or more (e.g., one, two, three, four, one or two, one to three, or one to four) additional therapeutic agents which are suitable for treating an HBV infection.
• the compounds described herein may be used or combined with one or more of a chemotherapeutic agent, an immunomodulator, an immunotherapeutic agent, a therapeutic antibody, a therapeutic vaccine, a bispecific antibody and “antibody-like” therapeutic protein (such as DARTs®, Duobodies®, Bites®, XmAbs®, TandAbs®, Fab derivatives), an antibody-drug conjugate (ADC), gene modifiers or gene editors (such as CRISPR Cas9, zinc finger nucleases, homing endonucleases, synthetic nucleases, TALENs), cell therapies such as CAR-T (chimeric antigen receptor T-cell), and TCR-T (an engineered T cell receptor) agent or any combination thereof.
• a chemotherapeutic agent such as DARTs®, Duobodies®, Bites®, XmAbs®, TandAbs®, Fab derivatives
• ADC antibody-drug conjugate
• gene modifiers or gene editors such as CRISPR
• a compound of the present disclosure is formulated as a tablet, which may optionally contain one or more other compounds useful for treating HBV.
• the tablet can contain another active ingredient for treating HBV, such as 3-dioxygenase (IDO) inhibitors, Apolipoprotein A1 modulator, arginase inhibitors, B- and T-lymphocyte attenuator inhibitors, Bruton's tyrosine kinase (BTK) inhibitors, CCR2 chemokine antagonist, CD137 inhibitors, CD160 inhibitors, CD305 inhibitors, CD4 agonist and modulator, compounds targeting HBcAg, compounds targeting hepatitis B core antigen (HBcAg), core protein allosteric modulators, covalently closed circular DNA (cccDNA) inhibitors, cyclophilin inhibitors, cytotoxic T-lymphocyte-associated protein 4 (ipi4) inhibitors, DNA polymerase inhibitor, Endonuclease modulator, epigenetic modifiers,
• IDO 3-di
• combination drugs for the treatment of HBV include TRUVADA® (tenofovir disoproxil fumarate and emtricitabine); ABX-203, lamivudine, and PEG-IFN-alpha; ABX-203 adefovir, and PEG-IFNalpha; and INO-1800 (INO-9112 and RG7944).
• TRUVADA® tenofovir disoproxil fumarate and emtricitabine
• ABX-203 lamivudine
• PEG-IFN-alpha ABX-203 adefovir
• PEG-IFNalpha PEG-IFNalpha
• INO-1800 INO-9112 and RG7944
• Examples of other drugs for the treatment of HBV include alpha-hydroxytropolones, amdoxovir, beta-hydroxycytosine nucleosides, AL-034, CCC-0975, elvucitabine, ezetimibe, cyclosporin A, gentiopicrin (gentiopicroside), JNJ-56136379, nitazoxanide, birinapant, NJK14047, NOV-205 (molixan, BAM-205), oligotide, mivotilate, feron, GST-HG-131, levamisole, Ka Shu Ning, alloferon, WS-007, Y-101 (Ti Fen Tai), rSIFN-co, PEG-IIFNm, KW-3, BP-Inter-014, oleanolic acid, HepB-nRNA, cTP-5 (rTP-5), HSK-II-2, HEISCO-106-1, HEISCO-106, Hepbam
• HBV vaccines include both prophylactic and therapeutic vaccines.
• HBV prophylactic vaccines include Vaxelis, Hexaxim, Heplisav, Mosquirix, DTwP-HBV vaccine, Bio-Hep-B, D/T/P/HBV/M (LBVP-0101; LBVW-0101), DTwP-Hepb-Hib-IPV vaccine, Heberpenta L, DTwP-HepB-Hib, V-419, CVI-HBV-001, Tetrabhay, hepatitis B prophylactic vaccine (Advax Super D), Hepatrol-07, GSK-223192A, ENGERIX B®, recombinant hepatitis B vaccine (intramuscular, Kangtai Biological Products), recombinant hepatitis B vaccine (Hansenual polymorpha yeast, intramuscular, Hualan Biological Engineering), recombinant hepatitis B surface antigen vaccine, Bimmugen, Eu
• HBV therapeutic vaccines include HBsAG-HBIG complex, ARB-1598, Bio-Hep-B, NASVAC, abi-HB (intravenous), ABX-203, Tetrabhay, GX-110E, GS-4774, peptide vaccine (epsilonPA-44), Hepatrol-07, NASVAC (NASTERAP), IMP-321, BEVAC, Revac B mcf, Revac B+, MGN-1333, KW-2, CVI-HBV-002, AltraHepB, VGX-6200, FP-02, FP-02.2, TG-1050, NU-500, HBVax, im/TriGrid/antigen vaccine, Mega-CD40L-adjuvanted vaccine, HepB-v, RG7944 (INO-1800), recombinant VLP-based therapeutic vaccine (HBV infection, VLP Biotech), AdTG-17909, AdTG-17910 AdTG-18202, ChronVac-B, TG-1050
• HBV DNA polymerase inhibitors examples include adefovir (HEPSERA®), emtricitabine (EMTRIVA®), tenofovir disoproxil fumarate (VIREAD®), tenofovir alafenamide, tenofovir, tenofovir disoproxil, tenofovir alafenamide fumarate, tenofovir alafenamide hemifumarate, tenofovir dipivoxil, tenofovir dipivoxil fumarate, tenofovir octadecyloxyethyl ester, CMX-157, besifovir, entecavir (BARACLUDE®), entecavir maleate, telbivudine (TYZEKA®), filocilovir, pradefovir, clevudine, ribavirin, lamivudine (EPIVIR-HBV®), phosphazide, fam
• immunomodulators examples include rintatolimod, imidol hydrochloride, ingaron, dermaVir, plaquenil (hydroxychloroquine), proleukin, hydroxyurea, mycophenolate mofetil (MPA) and its ester derivative mycophenolate mofetil (MMF), JNJ-440, WF-10, AB-452, ribavirin, IL-12, INO-9112, polymer polyethyleneimine (PEI), Gepon, VGV-1, MOR-22, CRV-431, JNJ-0535, TG-1050, ABI-H2158, BMS-936559, GS-9688, RO-7011785, RG-7854, AB-506, RO-6871765, AIC-649, and IR-103.
• TLR Toll-Like Receptor
• TLR modulators include modulators of TLR1, TLR2, TLR3, TLR4, TLR5, TLR6, TLR7, TLR8, TLR9, TLR10, TLR11, TLR12, and TLR13.
• TLR3 modulators include rintatolimod, poly-ICLC, RIBOXXON®, Apoxxim, RIBOXXIM®, IPH-33, MCT-465, MCT-475, and ND-1.1.
• TLR7 modulators include GS-9620, GSK-2245035, imiquimod, resiquimod, DSR-6434, DSP-3025, IMO-4200, MCT-465, MEDI-9197, 3M-051, SB-9922, 3M-052, Limtop, D, telratolimod, SP-0509, TMX-30X, TMX-202, RG-7863, RG-7795, LHC-165, RG-7854, and the compounds disclosed in US20100143301 (Gilead Sciences), US20110098248 (Gilead Sciences), and US20090047249 (Gilead Sciences).
• TLR8 modulators include motolimod, resiquimod, 3M-051, 3M-052, MCT-465, IMO-4200, VTX-763, VTX-1463, GS-9688 and the compounds disclosed in US20140045849 (Janssen), US20140073642 (Janssen), WO2014/056953 (Janssen), WO2014/076221 (Janssen), WO2014/128189 (Janssen), US20140350031 (Janssen), WO2014/023813 (Janssen), US20080234251 (Array Biopharma), US20080306050 (Array Biopharma), US20100029585 (Ventirx Pharma), US20110092485 (Ventirx Pharma), US20110118235 (Ventirx Pharma), US20120082658 (Ventirx Pharma), US20120219615 (Ventirx Pharma), US20140066432 (Ventirx Pharma), US20140088085 (Ventirx
• TLR9 modulators examples include BB-001, BB-006, CYT-003, IMO-2055, IMO-2125, IMO-3100, IMO-8400, IR-103, IMO-9200, agatolimod, DIMS-9054, DV-1079, DV-1179, AZD-1419, leftolimod (MGN-1703), litenimod, and CYT-003-QbG10.
• TLR7, TLR8 and TLR9 modulators include the compounds disclosed in WO2017047769 (Teika Seiyaku), WO2015014815 (Janssen), WO2018045150(Gilead Sciences Inc), WO2018045144 (Gilead Sciences Inc), WO2015162075(Roche), WO2017034986 (University of Kansas), WO2018095426 (Jiangsu Hengrui Medicine Co Ltd), WO2016091698(Roche), WO2016075661 (GlaxoSmithKline Biologicals), WO2016180743 (Roche), WO2018089695 (Dynavax Technologies), WO2016055553 (ROche), WO2015168279 (Novartis), WO2016107536 (Medshine Discovery), WO2018086593 (Livo (Shanghai) Pharmaceutical), WO2017106607(Merck), WO2017061532 (Sumitomo Dainippon Pharma), WO20160235
• interferon alpha receptor ligands examples include interferon alpha-2b (INTRON A®), pegylated interferon alpha-2a (PEGASYS®), PEGylated interferon alpha-1b, interferon alpha 1b (HAPGEN®), Veldona, Infradure, Roferon-A, YPEG-interferon alfa-2a (YPEG-rhIFNalpha-2a), P-1101, Algeron, Alfarona, Ingaron (interferon gamma), rSIFN-co (recombinant super compound interferon), Ypeginterferon alfa-2b (YPEG-rhIFNalpha-2b), MOR-22, peginterferon alfa-2b (PEG-INTRON®), Bioferon, Novaferon, Inmutag (Inferon), MULTIFERON®, interferon alfa-n1 (HUMOFERON®), interferon beta-1a (AVONEX®),
• hyaluronidase inhibitors examples include astodrimer.
• HsAg Hepatitis B Surface Antigen
• HBsAg inhibitors examples include HBF-0259, PBHBV-001, PBHBV-2-15, PBHBV-2-1, REP-9AC, REP-9C, REP-9, REP-2139, REP-2139-Ca, REP-2165, REP-2055, REP-2163, REP-2165, REP-2053, REP-2031 and REP-006, and REP-9AC′.
• HBsAg secretion inhibitors examples include BM601.
• Cytotoxic T-lymphocyte-associated protein 4 (ipi4) inhibitors include AGEN-2041, AGEN-1884, ipilumimab, belatacept, PSI-001, PRS-010, Probody mAbs, tremelimumab, and JHL-1155.
• cyclophilin inhibitors include CPI-431-32, EDP-494, OCB-030, SCY-635, NVP-015, NVP-018, NVP-019, STG-175, and the compounds disclosed in U.S. Pat. No. 8,513,184 (Gilead Sciences), US20140030221 (Gilead Sciences), US20130344030 (Gilead Sciences), and US20130344029 (Gilead Sciences).
• HBV viral entry inhibitors examples include Myrcludex B.
• antisense oligonucleotide targeting viral mRNA examples include ISIS-HBVRx, IONIS-HBVRx, IONIS-GSK6-LRx, GSK-3389404, RG-6004.
• Short Interfering RNAs siRNA
• ddRNAi short Interfering RNAs
• siRNA examples include TKM-HBV (TKM-HepB), ALN-HBV, SR-008, HepB-nRNA, and ARC-520, ARC-521, ARB-1740, ARB-1467.
• ddRNAi DNA-directed RNA interference
• inhibitors of ribonucleotide reductase include Trimidox.
• HBV E antigen inhibitors examples include wogonin.
• cccDNA inhibitors examples include BSBI-25, and CHR-101.
• farnesoid x receptor agonist such as EYP-001, GS-9674, EDP-305, MET-409, Tropifexor, AKN-083, RDX-023, BWD-100, LMB-763, INV-3, NTX-023-1, EP-024297 and GS-8670
• HBV antibodies targeting the surface antigens of the hepatitis B virus include GC-1102, XTL-17, XTL-19, KN-003, IV Hepabulin SN, and fully human monoclonal antibody therapy (hepatitis B virus infection, Humabs BioMed).
• HBV antibodies including monoclonal antibodies and polyclonal antibodies
• examples of HBV antibodies include Zutectra, Shang Sheng Gan Di, Uman Big (Hepatitis B Hyperimmune), Omri-Hep-B, Nabi-HB, Hepatect CP, HepaGam B, igantibe, Niuliva, CT-P24, hepatitis B immunoglobulin (intravenous, pH4, HBV infection, Shanghai RAAS Blood Products), and Fovepta (BT-088).
• Fully human monoclonal antibodies include HBC-34.
• thymosin agonists include Thymalfasin, recombinant thymosin alpha 1 (GeneScience)
• cytokines examples include recombinant IL-7, CYT-107, interleukin-2 (IL-2, Immunex), recombinant human interleukin-2 (Shenzhen Neptunus), IL-15, IL-21, IL-24, and celmoleukin.
• Nucleoprotein modulators may be either HBV core or capsid protein inhibitors.
• Examples of nucleoprotein modulators include GS-4882, AB-423, AT-130, GLS4, NVR-1221, NVR-3778, AL-3778, BAY 41-4109, morphothiadine mesilate, ARB-168786, ARB-880, JNJ-379, RG-7907, HEC-72702, AB-506, ABI-H0731, JNJ-440, ABI-H2158 and DVR-23.
• capsid inhibitors include the compounds disclosed in US20140275167 (Novira herapeutics), US20130251673 (Novira herapeutics), US20140343032 (Roche), WO2014037480 (Roche), US20130267517 (Roche), WO2014131847 (Janssen), WO2014033176 (Janssen), WO2014033170 (Janssen), WO2014033167 (Janssen), WO2015/059212 (Janssen), WO2015118057(Janssen), WO2015011281 (Janssen), WO2014184365 (Janssen), WO2014184350 (Janssen), WO2014161888 (Janssen), WO2013096744 (Novira), US20150225355 (Novira), US20140178337 (Novira), US20150315159 (Novira), US20150197533 (Novira), US20150274652 (Novira), US20150259324, (Novir
• transcript inhibitors include the compounds disclosed in WO2017013046 (Roche), WO2017016960 (Roche), WO2017017042 (Roche), WO2017017043 (Roche), WO2017061466 (Toyoma chemicals), WO2016177655 (Roche), WO2016161268 (Enanta).
• WO2017001853 Redex Pharma
• WO2017211791 (Roche)
• WO2017216685 Novartis
• WO2017216686 Novartis
• WO2018019297 Ginkgo Pharma
• WO2018022282 Newave Pharma
• US20180030053 Novartis
• WO2018045911 Zhejiang Pharma
• Examples of stimulators of retinoic acid-inducible gene 1 include SB-9200, SB-40, SB-44, ORI-7246, ORI-9350, ORI-7537, ORI-9020, ORI-9198, and ORI-7170, RGT-100.
• Examples of stimulators of NOD2 include SB-9200.
• PI3K inhibitors include idelalisib, ACP-319, AZD-8186, AZD-8835, buparlisib, CDZ-173, CLR-457, pictilisib, neratinib, rigosertib, rigosertib sodium, EN-3342, TGR-1202, alpelisib, duvelisib, IPI-549, UCB-5857, taselisib, XL-765, gedatolisib, ME-401, VS-5584, copanlisib, CAI orotate, perifosine, RG-7666, GSK-2636771, DS-7423, panulisib, GSK-2269557, GSK-2126458, CUDC-907, PQR-309, INCB-40093, pilaralisib, BAY-1082439, puquitinib mesylate, SAR-2454
• IDO inhibitors examples include epacadostat (INCB24360), resminostat (4SC-201), indoximod, F-001287, SN-35837, NLG-919, GDC-0919, GBV-1028, GBV-1012, NKTR-218, and the compounds disclosed in US20100015178 (Incyte), US2016137652 (Flexus Biosciences, Inc.), WO2014073738 (Flexus Biosciences, Inc.), and WO2015188085 (Flexus Biosciences, Inc.).
• PD-1 inhibitors include cemiplimab, nivolumab, pembrolizumab, pidilizumab, BGB-108, STI-A1014, SHR-1210, PDR-001, PF-06801591, IBI-308, GB-226, S11-1110, JNJ-63723283, CA-170, durvalumab, atezolizumab and mDX-400, JS-001, Camrelizumab, Sintilimab, Sintilimab, tislelizumab, BCD-100, BGB-A333 JNJ-63723283, GLS-010 (WBP-3055), CX-072, AGEN-2034, GNS-1480 (Epidermal growth factor receptor antagonist; Programmed cell death ligand 1 inhibitor), CS-1001, M-7824 (PD-L1/TGF- ⁇ bifunctional fusion protein), Genolimzumab, BMS-936559
• Examples of PD-L1 inhibitors include atezolizumab, avelumab, AMP-224, MEDI-0680, RG-7446, GX-P2, durvalumab, KY-1003, KD-033, MSB-0010718C, TSR-042, ALN-PDL, STI-A1014, GS-4224, CX-072, and BMS-936559.
• Examples of PD-1 inhibitors include the compounds disclosed in WO2017112730 (Incyte Corp), WO2017087777 (Incyte Corp), WO2017017624, WO2014151634 (BristolMyers Squibb Co), WO201317322 (BristolMyers Squibb Co), WO2018119286 (Incyte Corp), WO2018119266 (Incyte Corp), WO2018119263 (Incyte Corp), WO2018119236 (Incyte Corp), WO2018119221 (Incyte Corp), WO2018118848 (BristolMyers Squibb Co), WO20161266460 (BristolMyers Squibb Co), WO2017087678 (BristolMyers Squibb Co), WO2016149351 (BristolMyers Squibb Co), WO2015033299 (Aurigene Discovery Technologies Ltd), WO2015179615 (Eisai Co Ltd; Eisai Research Institute),
• recombinant thymosin alpha-1 examples include NL-004 and PEGylated thymosin alpha-1.
• BTK inhibitors examples include ABBV-105, acalabrutinib (ACP-196), ARQ-531, BMS-986142, dasatinib, ibrutinib, GDC-0853, PRN-1008, SNS-062, ONO-4059, BGB-3111, ML-319, MSC-2364447, RDX-022, X-022, AC-058, RG-7845, spebrutinib, TAS-5315, TP-0158, TP-4207, HM-71224, KBP-7536, M-2951, TAK-020, AC-0025, and the compounds disclosed in US20140330015 (Ono Pharmaceutical), US20130079327 (Ono Pharmaceutical), and US20130217880 (Ono Pharmaceutical).
• KDM5 inhibitors include the compounds disclosed in WO2016057924 (Genentech/Constellation Pharmaceuticals), US20140275092 (Genentech/Constellation Pharmaceuticals), US20140371195 (Epitherapeutics) and US20140371214 (Epitherapeutics), US20160102096 (Epitherapeutics), US20140194469 (Quanticel), US20140171432, US20140213591 (Quanticel), US20160039808 (Quanticel), US20140275084 (Quanticel), WO2014164708 (Quanticel).
• KDM1 inhibitors include the compounds disclosed in U.S. Pat. No. 9,186,337B2 (Oryzon Genomics), GSK-2879552, and RG-6016.
• STING agonists include SB-11285, AdVCA0848, STINGVAX, and the compounds disclosed in WO 2018065360 (“Biolog Life Science Institute Klaslabor und Biochemica-Vertrieb GmbH, Germany), WO 2018009466 (Aduro Biotech), WO 2017186711 (InvivoGen), WO 2017161349 (Immune Sensor), WO 2017106740 (Aduro Biotech), US 20170158724 (Glaxo SmithKline), WO 2017075477 (Aduro Biotech), US 20170044206 (Merck), WO 2014179760 (University of California), WO2018098203 (Janssn), WO2018118665 (Merck), WO2018118664 (Merck), WO2018100558 (Takeda), WO2018067423 (Merck), WO2018060323 (Boehringer).
• NRTI Non-Nucleoside Reverse Transcriptase Inhibitors
• NNRTI examples include the compounds disclosed in WO2018118826 (Merck), WO2018080903 (Merck), WO2018119013 (Merck), WO2017100108 (Idenix), WO2017027434 (Merck), WO2017007701 (Merck), WO2008005555 (Gilead).
• hepatitis B virus replication inhibitors examples include isothiafludine, IQP-HBV, RM-5038, and Xingantie.
• Arginase inhibitors include CB-1158, C-201, and resminostat.
• Gene therapy and cell therapy includes the genetic modification to silence a gene; genetic approaches to directly kill the infected cells; the infusion of immune cells designed to replace most of the patient's own immune system to enhance the immune response to infected cells, or activate the patient's own immune system to kill infected cells, or find and kill the infected cells; and genetic approaches to modify cellular activity to further alter endogenous immune responsiveness against the infection.
• genome editing systems include a CRISPR/Cas9 system, a zinc finger nuclease system, a TALEN system, a homing endonucleases system, and a meganuclease system; e.g., cccDNA elimination via targeted cleavage, and altering one or more of the hepatitis B virus (HBV) viral genes.
• CRISPR/Cas9 CRISPR/Cas9
• zinc finger nuclease system e.g., a zinc finger nuclease system
• TALEN e.g., a TALEN system
• a homing endonucleases system e.g., cccDNA elimination via targeted cleavage
• HBV hepatitis B virus
• Altering e.g., knocking out and/or knocking down
• the PreC, C, X, PreSI, PreS2, S, P or SP gene refers to (1) reducing or eliminating PreC, C, X, PreSI, PreS2, S, P or SP gene expression, (2) interfering with Precore, Core, X protein, Long surface protein, middle surface protein, S protein (also known as HBs antigen and HBsAg), polymerase protein, and/or Hepatitis B spliced protein function (HBe, HBc, HBx, PreS1, PreS2, S, Pol, and/or HBSP or (3) reducing or eliminating the intracellular, serum and/or intraparenchymal levels of HBe, HBc, HBx, LHBs, MHBs, SHBs, Pol, and/or HBSP proteins. Knockdown of one or more of the PreC, C, X. PreSI PreS2. S, P and/or SP gene(s) is performed by targeting
• CAR T cell therapy includes a population of immune effector cells engineered to express a chimeric antigen receptor (CAR), wherein the CAR comprises an HBV antigen-binding domain.
• the immune effector cell is a T cell or an NK cell.
• the T cell is a CD4+ T cell, a CD8+ T cell, or a combination thereof.
• Cells can be autologous or allogeneic.
• TCR T cell therapy includes T cells expressing HBV-specific T cell receptors.
• TCR-T cells are engineered to target HBV derived peptides presented on the surface of virus-infected cells.
• the T-cells express HBV surface antigen (HBsAg)-specific TCR.
• HBV surface antigen (HBsAg)-specific TCR examples of TCR-T therapy directed to treatment of HBV include LTCR-H2-1.
• a compound disclosed herein, or a pharmaceutically acceptable salt thereof is combined with an HBV DNA polymerase inhibitor, one or two additional therapeutic agents selected from the group consisting of immunomodulators, TLR modulators, HBsAg inhibitors, HBsAg secretion or assembly inhibitors, HBV therapeutic vaccines, HBV antibodies including HBV antibodies targeting the surface antigens of the hepatitis B virus and bispecific antibodies and “antibody-like” therapeutic proteins (such as DARTs®, DUOBODIES®, BITES®, XmAbs®, TandAbs®, Fab derivatives, or TCR-like antibodies), cyclophilin inhibitors, stimulators of retinoic acid-inducible gene 1, stimulators of RIG-I like receptors, PD-1 inhibitors, PD-L1 inhibitors, Arginase inhibitors, PI3K inhibitors, IDO inhibitors, and stimulators of NOD2, and one or two additional therapeutic agents selected from the group consisting of HBV viral entry inhibitors,
• a compound disclosed herein, or a pharmaceutically acceptable salt thereof is combined with an HBV DNA polymerase inhibitor and at least a second additional therapeutic agent selected from the group consisting of: immunomodulators, TLR modulators, HBsAg inhibitors, HBV therapeutic vaccines, HBV antibodies including HBV antibodies targeting the surface antigens of the hepatitis B virus and bispecific antibodies and “antibody-like” therapeutic proteins (such as DARTs®, DUOBODIES®, BITES®, XmAbs®, TandAbs®, Fab derivatives, or TCR-like antibodies), cyclophilin inhibitors, stimulators of retinoic acid-inducible gene 1, stimulators of RIG-I like receptors, PD-1 inhibitors, PD-L1 inhibitors, Arginase inhibitors, PI3K inhibitors, IDO inhibitors, and stimulators of NOD2.
• a second additional therapeutic agent selected from the group consisting of: immunomodulators, TLR modulators, HBsAg inhibitors, HBV therapeutic
• a compound disclosed herein, or a pharmaceutically acceptable salt thereof is combined with an HBV DNA polymerase inhibitor and at least a second additional therapeutic agent selected from the group consisting of: HBV viral entry inhibitors, NTCP inhibitors, HBx inhibitors, cccDNA inhibitors, HBV antibodies targeting the surface antigens of the hepatitis B virus, siRNA, miRNA gene therapy agents, sshRNAs, KDM5 inhibitors, and nucleoprotein modulators (HBV core or capsid protein inhibitors).
• a second additional therapeutic agent selected from the group consisting of: HBV viral entry inhibitors, NTCP inhibitors, HBx inhibitors, cccDNA inhibitors, HBV antibodies targeting the surface antigens of the hepatitis B virus, siRNA, miRNA gene therapy agents, sshRNAs, KDM5 inhibitors, and nucleoprotein modulators (HBV core or capsid protein inhibitors).
• a compound disclosed herein, or a pharmaceutically acceptable salt thereof is combined with compounds such as those disclosed in U.S. Publication No. 2010/0143301 (Gilead Sciences), U.S. Publication No. 2011/0098248 (Gilead Sciences), U.S. Publication No. 2009/0047249 (Gilead Sciences), U.S. Pat. No. 8,722,054 (Gilead Sciences), U.S. Publication No. 2014/0045849 (Janssen), U.S. Publication No. 2014/0073642 (Janssen), WO2014/056953 (Janssen), WO2014/076221 (Janssen), WO2014/128189 (Janssen), U.S.
• the compound of the disclosure may be employed with other therapeutic methods of cancer treatment.
• combination therapy with chemotherapeutic, hormonal, antibody, surgical and/or radiation treatments are contemplated.
• the further anti-cancer therapy is surgery and/or radiotherapy.
• the further anti-cancer therapy is at least one additional cancer medicament.
• a combination comprising a compound of the present disclosure, or a pharmaceutically acceptable salt thereof and at least one further cancer medicament.
• a combination comprising a compound of the present disclosure, or a pharmaceutically acceptable salt thereof and at least one further cancer medicament, for use in therapy.
• a combination comprising a compound of the present disclosure, or a pharmaceutically acceptable salt thereof and at least one cancer medicament, in the manufacture of a medicament for the treatment of cancer.
• cancer medicaments include intercalating substances such as anthracycline, doxorubicin, idarubicin, epirubicin, and daunorubicin; topoisomerase inhibitors such as irinotecan, topotecan, camptothecin, lamellarin D, etoposide, teniposide, mitoxantrone, amsacrine, ellipticines and aurintricarboxylic acid; nitrosourea compounds such as carmustine (BCNU), lomustine (CCNU), and streptozocin; nitrogen mustards such as cyclophosphamide, mechlorethamine, uramustine, bendamustine, melphalan, chlorambucil, mafosfamide, trofosfamid and ifosfamide; alkyl sulfonates such as busulfan and treosulfan; alkylating agents such as procarbazin, dacarba,
• a method for treating or preventing a hyperproliferative disorder or cancer in a human or animal having or at risk of having the hyperproliferative disorder or cancer comprising administering to the human or animal a therapeutically effective amount of a compound of the present disclosure, or a pharmaceutically acceptable salt thereof, in combination with a therapeutically effective amount of one or more (e.g., one, two, three, one or two, or one to three) additional therapeutic agents.
• a method for treating or preventing a hyperproliferative disorder or cancer in a human or animal having or at risk of having the hyperproliferative disorder or cancer comprising administering to the human or animal a therapeutically effective amount of a compound of the present disclosure, or a pharmaceutically acceptable salt thereof, in combination with a therapeutically effective amount of one or more (e.g., one, two, three, one or two, or one to three) additional therapeutic agents.
• a method for treating a hyperproliferative disorder or cancer in a human or animal having or at risk of having the hyperproliferative disorder or cancer comprising administering to the human or animal a therapeutically effective amount of a compound disclosed herein, or a pharmaceutically acceptable salt thereof, in combination with a therapeutically effective amount of one or more (e.g., one, two, three, one or two, or one to three) additional therapeutic agents.
• a therapeutically effective amount of a compound disclosed herein, or a pharmaceutically acceptable salt thereof in combination with a therapeutically effective amount of one or more (e.g., one, two, three, one or two, or one to three) additional therapeutic agents.
• the compounds described herein may be used or combined with one or more of a chemotherapeutic agent, an anti-cancer agent, an anti-angiogenic agent, an anti-fibrotic agent, an immunotherapeutic agent, a therapeutic antibody, a bispecific antibody and “antibody-like” therapeutic protein (such as DARTs®, Duobodies®, Bites®, XmAbs®, TandAbs®, Fab derivatives), an antibody-drug conjugate (ADC), a radiotherapeutic agent, an anti-neoplastic agent, an anti-proliferation agent, an oncolytic virus, a gene modifier or editor (such as CRISPR/Cas9, zinc finger nucleases or synthetic nucleases, TALENs), a CAR (chimeric antigen receptor) T-cell immunotherapeutic agent, an engineered T cell receptor (TCR-T), or any combination thereof.
• a chemotherapeutic agent an anti-cancer agent, an anti-angiogenic agent, an anti-fibrotic agent, an immuno
• therapeutic agents may be in the forms of compounds, antibodies, polypeptides, or polynucleotides.
• a product comprising a compound described herein and an additional therapeutic agent as a combined preparation for simultaneous, separate, or sequential use in therapy.
• the one or more therapeutic agents include, but are not limited to, an inhibitor, agonist, antagonist, ligand, modulator, stimulator, blocker, activator or suppressor of a gene, ligand, receptor, protein, or factor.
• additional therapeutic agents include: Abelson murine leukemia viral oncogene homolog 1 gene (ABL, such as ABL1), Acetyl-CoA carboxylase (such as ACC1/2), activated CDC kinase (ACK, such as ACK1), Adenosine deaminase, adenosine receptor (such as A2B, A2a, A3), Adenylate cyclase, ADP ribosyl cyclase-1, adrenocorticotropic hormone receptor (ACTH), Aerolysin, AKT1 gene, Alk-5 protein kinase, Alkaline phosphatase, Alpha 1 adrenoceptor, Alpha 2 adrenoceptor, Alpha-ketoglu
• Non-limiting examples of additional therapeutic agents may be categorized by their mechanism of action into, for example, the following groups:
• a hyperproliferative disorder or cancer in a human or animal having or at risk of having the hyperproliferative disorder or cancer comprising administering to the human or animal a therapeutically effective amount of a compound of the present disclosure or a pharmaceutically acceptable salt thereof, in combination with a therapeutically effective amount of one or more (e.g., one, two, three, one or two, or one to three) additional therapeutic agents selected from the group consisting of apoptosis signal-regulating kinase (ASK) inhibitors; Bruton's tyrosine kinase (BTK) inhibitors; cluster of differentiation 47 (CD47) inhibitors; cyclin-dependent kinase (CDK) inhibitors; discoidin domain receptor (DDR) inhibitors; histone deacetylase (HDAC) inhibitors; indoleamine-pyrrole-2,3-dioxygenase (IDO1) inhibitors; Janus kinase (ASK) inhibitors; Bruton's
• chemotherapeutic agent or “chemotherapeutic” (or “chemotherapy” in the case of treatment with a chemotherapeutic agent) is meant to encompass any non-proteinaceous (i.e., non-peptidic) chemical compound useful in the treatment of cancer.
• chemotherapeutic agents include but are not limited to: alkylating agents such as thiotepa and cyclophosphamide (CYTOXAN®); alkyl sulfonates such as busulfan, improsulfan, and piposulfan; aziridines such as benzodepa, carboquone, meturedepa, and uredepa; ethylenimines and methylamelamines including altretamine, triethylenemelamine, triethylenephosphoramide, triethylenethiophosphoramide, and trimemylolomelamine; acetogenins, especially bullatacin and bullatacinone; a camptothecin, including synthetic analog topotecan; bryostatin, callystatin; CC-1065, including its adozelesin, carzelesin, and bizelesin synthetic analogs; cryptophycins, particularly cryptophycin 1 and cryptophycin 8; dolastatin; duocarmycin
• chemotherapeutic agent are anti-hormonal agents such as anti-estrogens and selective estrogen receptor modulators (SERMs), inhibitors of the enzyme aromatase, anti-androgens, and pharmaceutically acceptable salts, acids or derivatives of any of the above that act to regulate or inhibit hormone action on tumors.
• SERMs selective estrogen receptor modulators
• anti-estrogens and SERMs include, for example, tamoxifen (including NOLVADEXTM), raloxifene, droloxifene, 4-hydroxytamoxifen, trioxifene, keoxifene, LY117018, onapristone, and toremifene (FARESTON®).
• Inhibitors of the enzyme aromatase regulate estrogen production in the adrenal glands include 4(5)-imidazoles, aminoglutethimide, megestrol acetate (MEGACE®), exemestane, formestane, fadrozole, vorozole (RIVISOR®), letrozole (FEMARA®), and anastrozole (ARIMIDEX®).
• anti-androgens examples include apalutamide, abiraterone, enzalutamide, flutamide, galeterone, nilutamide, bicalutamide, leuprolide, goserelin, ODM-201, APC-100, ODM-204.
• progesterone receptor antagonist examples include onapristone.
• Anti-angiogenic agents include, but are not limited to, retinoid acid and derivatives thereof, 2-methoxyestradiol, ANGIOSTATIN®, ENDOSTATIN®, regorafenib, necuparanib, suramin, squalamine, tissue inhibitor of metalloproteinase-1, tissue inhibitor of metalloproteinase-2, plasminogen activator inhibitor-1, plasminogen activator inhibitor-2, cartilage-derived inhibitor, paclitaxel (nab-paclitaxel), platelet factor 4, protamine sulphate (clupeine), sulphated chitin derivatives (prepared from queen crab shells), sulphated polysaccharide peptidoglycan complex (sp-pg), staurosporine, modulators of matrix metabolism including proline analogs such as 1-azetidine-2-carboxylic acid (LACA), cishydroxyproline, d,I-3,4-dehydroproline, thiaproline, ⁇
• anti-angiogenesis agents include antibodies, preferably monoclonal antibodies against these angiogenic growth factors: beta-FGF, alpha-FGF, FGF-5, VEGF isoforms, VEGF-C, HGF/SF, and Ang-1/Ang-2.
• Anti-fibrotic agents include, but are not limited to, the compounds such as beta-aminoproprionitrile (BAPN), as well as the compounds disclosed in U.S. Pat. No. 4,965,288 relating to inhibitors of lysyl oxidase and their use in the treatment of diseases and conditions associated with the abnormal deposition of collagen and U.S. Pat. No. 4,997,854 relating to compounds which inhibit LOX for the treatment of various pathological fibrotic states, which are herein incorporated by reference. Further exemplary inhibitors are described in U.S. Pat. No. 4,943,593 relating to compounds such as 2-isobutyl-3-fluoro-, chloro-, or bromo-allylamine, U.S. Pat. Nos.
• BAPN beta-aminoproprionitrile
• Exemplary anti-fibrotic agents also include the primary amines reacting with the carbonyl group of the active site of the lysyl oxidases, and more particularly those which produce, after binding with the carbonyl, a product stabilized by resonance, such as the following primary amines: emylenemamine, hydrazine, phenylhydrazine, and their derivatives; semicarbazide and urea derivatives; aminonitriles such as BAPN or 2-nitroethylamine; unsaturated or saturated haloamines such as 2-bromo-ethylamine, 2-chloroethylamine, 2-trifluoroethylamine, 3-bromopropylamine, and p-halobenzylamines; and selenohomocysteine lactone.
• primary amines reacting with the carbonyl group of the active site of the lysyl oxidases, and more particularly those which produce, after binding with the carbonyl, a product
• anti-fibrotic agents are copper chelating agents penetrating or not penetrating the cells.
• Exemplary compounds include indirect inhibitors which block the aldehyde derivatives originating from the oxidative deamination of the lysyl and hydroxylysyl residues by the lysyl oxidases.
• Examples include the thiolamines, particularly D-penicillamine, and its analogs such as 2-amino-5-mercapto-5-methylhexanoic acid, D-2-amino-3-methyl-3-((2-acetamidoethyl)dithio)butanoic acid, p-2-amino-3-methyl-3-((2-aminoethyl)dithio)butanoic acid, sodium-4-((p-1-dimethyl-2-amino-2-carboxyethyl)dithio)butane sulphurate, 2-acetamidoethyl-2-acetamidoethanethiol sulphanate, and sodium-4-mercaptobutanesulphinate trihydrate.
• the immunotherapeutic agents include and are not limited to therapeutic antibodies suitable for treating subjects.
• Some examples of therapeutic antibodies include abagovomab, ABP-980, adecatumumab, afutuzumab, alemtuzumab, altumomab, amatuximab, anatumomab, arcitumomab, bavituximab, bectumomab, bevacizumab, bivatuzumab, blinatumomab, brentuximab, cantuzumab, catumaxomab, CC49, cetuximab, citatuzumab, cixutumumab, clivatuzumab, conatumumab, dacetuzumab, dalotuzumab, daratumumab, detumomab, dinutuximab, drozitumab, duligotumab,
• the exemplified therapeutic antibodies may be further labeled or combined with a radioisotope particle such as indium-111, yttrium-90 (90Y-clivatuzumab), or iodine-131.
• a radioisotope particle such as indium-111, yttrium-90 (90Y-clivatuzumab), or iodine-131.
• Cancer Gene Therapy and Cell Therapy includes the insertion of a normal gene into cancer cells to replace a mutated or altered gene; genetic modification to silence a mutated gene; genetic approaches to directly kill the cancer cells; including the infusion of immune cells designed to replace most of the subject's own immune system to enhance the immune response to cancer cells, or activate the subject's own immune system (T cells or Natural Killer cells) to kill cancer cells, or find and kill the cancer cells; genetic approaches to modify cellular activity to further alter endogenous immune responsiveness against cancer.
• genome editing system examples include a CRISPR/Cas9 system, a zinc finger nuclease system, a TALEN system, a homing endonucleases system, and a meganuclease system.
• CAR-T cell therapy includes a population of immune effector cells engineered to express a chimeric antigen receptor (CAR), wherein the CAR comprises a tumor antigen-binding domain.
• the immune effector cell is a T cell or an NK cell.
• TCR-T cell therapy includes TCR-T cells that are engineered to target tumor derived peptides present on the surface of tumor cells. Cells can be autologous or allogeneic.
• the CAR comprises an antigen binding domain, a transmembrane domain, and an intracellular signalling domain.
• the intracellular domain comprises a primary signaling domain, a costimulatory domain, or both of a primary signaling domain and a costimulatory domain.
• the primary signaling domain comprises a functional signaling domain of one or more proteins selected from the group consisting of CD3 zeta, CD3 gamma, CD3 delta, CD3 epsilon, common FcR gamma (FCERIG), FcR beta (Fc Epsilon Rlb), CD79a, CD79b, Fcgamma RIIa, DAP10, and DAP12.
• a functional signaling domain of one or more proteins selected from the group consisting of CD3 zeta, CD3 gamma, CD3 delta, CD3 epsilon, common FcR gamma (FCERIG), FcR beta (Fc Epsilon Rlb), CD79a, CD79b, Fcgamma RIIa, DAP10, and DAP12.
• the costimulatory domain comprises a functional domain of one or more proteins selected from the group consisting of CD27, CD28, 4-1BB(CD137), OX40, CD30, CD40, PD-1, ICOS, lymphocyte function-associated antigen-1 (LFA-I), CD2, CD7, LIGHT, NKG2C, B7-H3, a ligand that specifically binds with CD83, CDS, ICAM-1, GITR, BAFFR, HVEM (LIGHTR), SLAMF7, NKp80 (KLRFI), CD160, CD19, CD4, CD8alpha, CD8beta, IL2R beta, IL2R gamma, IL7R alpha, ITGA4, VLA1, CD49a, ITGA4, IA4, CD49D, ITGA6, VLA-6, CD49f, ITGAD, CD 1 id, ITGAE, CD103, ITGAL, CD 1 la, LFA-1, ITGAM, CD1 lb, ITGA
• the transmembrane domain comprises a transmembrane domain of a protein selected from the group consisting of the alpha, beta or zeta chain of the T-cell receptor, CD28, CD3 epsilon, CD45, CD4, CD5, CD8, CD9, CD16, CD22, CD33, CD37, CD64, CD80, CD86, CD134, CD137, CD154, KIRDS2, OX40, CD2, CD27, LFA-1 (CD1 la, CD18), ICOS (CD278), 4-1BB(CD137), GITR, CD40, BAFFR, HVEM (LIGHTR), SLAMF7, NKp80 (KLRF1), CD160, CD19, IL2R beta, IL2R gamma, IL7R u, ITGA1, VLA1, CD49a, ITGA4, IA4, CD49D, ITGA6, VLA-6, CD49f, ITGAD, CD1 ld, ITGAE, CD103, ITG
• the antigen binding domain binds a tumor antigen.
• the tumor antigen is selected from the group consisting of: CD19; CD123; CD22; CD30; CD171; CS-1 (also referred to as CD2 subset 1, CRACC, SLAMF7, CD319, and 19A24); C-type lectin-like molecule-1 (CLL-1 or CLECLI); CD33; epidermal growth factor receptor variant III (EGFRvlll); ganglioside G2 (GD2); ganglioside GD3 (aNeuSAc(2-8)aNeuSAc(2-3)bDGaip(1-4)bDGIcp(1-1)Cer); TNF receptor family member B cell maturation (BCMA); Tn antigen ((Tn Ag) or (GaINAcu-Ser/Thr)); prostate-specific membrane antigen (PSMA); Receptor tyrosine kinase-like orphan receptor 1 (RORI); Fms-Like, Tyrosine Kinase 3 (FLT3); Tumor-associated glycoprotein 72 (
• the tumor antigen is selected from CD150, 5T4, ActRIIA, B7, BMCA, CA-125, CCNA1, CD123, CD126, CD138, CD14, CD148, CD15, CD19, CD20, CD200, CD21, CD22, CD23, CD24, CD25, CD26, CD261, CD262, CD30, CD33, CD362, CD37, CD38, CD4, CD40, CD40L, CD44, CD46, CD5, CD52, CD53, CD54, CD56, CD66a-d, CD74, CD8, CD80, CD92, CE7, CS-1, CSPG4, ED-B fibronectin, EGFR, EGFRvIII, EGP-2, EGP-4, EPHa2, ErbB2, ErbB3, ErbB4, FBP, GD2, GD3, HER1-HER2 in combination, HER2-HER3 in combination, HERV-K, HIV-1 envelope glycoprotein gp120, HIV-1 envelope glycoprotein gp41
• Non limiting examples of cell therapies include Algenpantucel-L, Sipuleucel-T, (BPX-501) rivogenlecleucel U.S. Pat. No. 9,089,520, WO2016100236, AU-105, ACTR-087, activated allogeneic natural killer cells CNDO-109-AANK, MG-4101, AU-101, BPX-601, FATE-NK100, LFU-835 hematopoietic stem cells, Imilecleucel-T, baltaleucel-T, PNK-007, UCARTCS1, ET-1504, ET-1501, ET-1502, ET-190, CD19-ARTEMIS, ProHema, FT-1050-treated bone marrow stem cell therapy, CD4CARNK-92 cells, CryoStim, AlloStim, lentiviral transduced huCART-meso cells, CART-22 cells, EGFRt/19-28zt4-1BBL CAR T cells, autologous 4
• the tumor targeting antigen includes: Alpha-fetoprotein, such as ET-1402, and AFP-TCR; Anthrax toxin receptor 1, such as anti-TEM8 CAR T-cell therapy; B cell maturation antigens (BCMA), such as bb-2121, UCART-BCMA, ET-140, KITE-585, MCM-998, LCAR-B38M, CART-BCMA, SEA-BCMA, BB212, UCART-BCMA, ET-140, P-BCMA-101, AUTO-2 (APRIL-CAR); Anti-CLL-1 antibodies, such as KITE-796; B7 homolog 6, such as CAR-NKp30 and CAR-B7H6; B-lymphocyte antigen CD19, such as TBI-1501, CTL-119 huCART-19 T cells, JCAR-015 U.S.
• BCMA B cell maturation antigens
• B7 homolog 6 such as CAR-NKp30 and CAR-B7H6
• the additional therapeutic agents are suitable for treating lymphoma or leukemia.
• these agents include aldesleukin, alvocidib, amifostine trihydrate, aminocamptothecin, antineoplaston A10, antineoplaston AS2-1, anti-thymocyte globulin, arsenic trioxide, Bcl-2 family protein inhibitor ABT-263, beta alethine, BMS-345541, bortezomib (VELCADE®), bortezomib (VELCADE®, PS-341), bryostatin 1, bulsulfan, campath-1H, carboplatin, carfilzomib (Kyprolis®), carmustine, caspofungin acetate, CC-5103, chlorambucil, CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisone), cisplatin, cladribine, clofarabine, curcumin,
• radioimmunotherapy wherein a monoclonal antibody is combined with a radioisotope particle, such as indium-111, yttrium-90, and iodine-131.
• a radioisotope particle such as indium-111, yttrium-90, and iodine-131.
• combination therapies include, but are not limited to, iodine-131 tositumomab (BEXXAR®), yttrium-90 ibritumomab tiuxetan (ZEVALIN®), and BEXXAR® with CHOP.
• Therapeutic procedures include peripheral blood stem cell transplantation, autologous hematopoietic stem cell transplantation, autologous bone marrow transplantation, antibody therapy, biological therapy, enzyme inhibitor therapy, total body irradiation, infusion of stem cells, bone marrow ablation with stem cell support, in vitro-treated peripheral blood stem cell transplantation, umbilical cord blood transplantation, immunoenzyme technique, low-LET cobalt-60 gamma ray therapy, bleomycin, conventional surgery, radiation therapy, and nonmyeloablative allogeneic hematopoietic stem cell transplantation.
• the additional therapeutic agents are suitable for treating non-Hodgkin's lymphomas (NHL), especially those of B cell origin, which include monoclonal antibodies, standard chemotherapy approaches (e.g., CHOP, CVP, FCM, MCP, and the like), radioimmunotherapy, and combinations thereof, especially integration of an antibody therapy with chemotherapy.
• NHL non-Hodgkin's lymphomas
• unconjugated monoclonal antibodies for the treatment of NHL/B-cell cancers include rituximab, alemtuzumab, human or humanized anti-CD20 antibodies, lumiliximab, anti-TNF-related apoptosis-inducing ligand (anti-TRAIL), bevacizumab, galiximab, epratuzumab, SGN-40, and anti-CD74.
• Examples of experimental antibody agents used in treatment of NHL/B-cell cancers include ofatumumab, ha20, PRO131921, alemtuzumab, galiximab, SGN-40, CHIR-12.12, epratuzumab, lumiliximab, apolizumab, milatuzumab, and bevacizumab.
• Examples of standard regimens of chemotherapy for NHIJB-cell cancers include CHOP, FCM, CVP, MCP, R-CHOP, R-FCM, R-CVP, and R-MCP.
• radioimmunotherapy for NHIJB-cell cancers examples include yttrium-90 ibritumomab tiuxetan (ZEVALIN®) and iodine-131 tositumomab (BEXXAR®).
• the additional therapeutic agents are suitable for treating mantle cell lymphoma (MCL), which include combination chemotherapies such as CHOP, hyperCVAD, and FCM. These regimens can also be supplemented with the monoclonal antibody rituximab to form combination therapies R-CHOP, hyperCVAD-R, and R-FCM. Any of the abovementioned therapies may be combined with stem cell transplantation or ICE in order to treat MCL.
• MCL mantle cell lymphoma
• therapeutic agents suitable for treating MCL include:
• the additional therapeutic agents are suitable for treating Waldenstrom's Macroglobulinemia (WM), which include aldesleukin, alemtuzumab, alvocidib, amifostine trihydrate, aminocamptothecin, antineoplaston A10, antineoplaston AS2-1, anti-thymocyte globulin, arsenic trioxide, autologous human tumor-derived HSPPC-96, Bcl-2 family protein inhibitor ABT-263, beta alethine, bortezomib (VELCADE®), bryostatin 1, busulfan, campath-1H, carboplatin, carmustine, caspofungin acetate, CC-5103, cisplatin, clofarabine, cyclophosphamide, cyclosporine, cytarabine, denileukin diftitox, dexamethasone, docetaxel, dolastatin 10, doxorubicin hydrochloride,
• WM Wald
• therapeutic procedures used to treat WM include peripheral blood stem cell transplantation, autologous hematopoietic stem cell transplantation, autologous bone marrow transplantation, antibody therapy, biological therapy, enzyme inhibitor therapy, total body irradiation, infusion of stem cells, bone marrow ablation with stem cell support, in vitro-treated peripheral blood stem cell transplantation, umbilical cord blood transplantation, immunoenzyme techniques, low-LET cobalt-60 gamma ray therapy, bleomycin, conventional surgery, radiation therapy, and nonmyeloablative allogeneic hematopoietic stem cell transplantation.
• the additional therapeutic agents are suitable for treating diffuse large B-cell lymphoma (DLBCL), which include cyclophosphamide, doxorubicin, vincristine, prednisone, anti-CD20 monoclonal antibodies, etoposide, bleomycin, many of the agents listed for WM, and any combination thereof, such as ICE and R-ICE.
• DLBCL diffuse large B-cell lymphoma
• the additional therapeutic agents are suitable for treating chronic lymphocytic leukemia (CLL), which include chlorambucil, cyclophosphamide, fludarabine, pentostatin, cladribine, doxorubicin, vincristine, prednisone, prednisolone, alemtuzumab, many of the agents listed for WM, and combination chemotherapy and chemoimmunotherapy, including the following common combination regimens: CVP, R-CVP, ICE, R-ICE, FCR, and FR.
• CLL chronic lymphocytic leukemia
• the additional therapeutic agents are suitable for treating myelofibrosis, which include hedgehog inhibitors, histone deacetylase (HDAC) inhibitors, and tyrosine kinase inhibitors.
• hedgehog inhibitors include saridegib and vismodegib.
• HDAC inhibitors include, but are not limited to, pracinostat and panobinostat.
• Non-limiting examples of tyrosine kinase inhibitors are lestaurtinib, bosutinib, imatinib, gilteritinib, radotinib, and cabozantinib.
• the additional therapeutic agents are suitable for treating a hyperproliferative disease, which include gemcitabine, nab-paclitaxel, and gemcitabine/nab-paclitaxel with a JAK inhibitor and/or PI3K8 inhibitor.
• the additional therapeutic agents are suitable for treating bladder cancer, which include atezolizumab, carboplatin, cisplatin, docetaxel, doxorubicin, fluorouracil (5-FU), gemcitabine, idosfamide, Interferon alfa-2b, methotrexate, mitomycin, nab-paclitaxel, paclitaxel, pemetrexed, thiotepa, vinblastine, and any combination thereof.
• atezolizumab carboplatin, cisplatin, docetaxel, doxorubicin, fluorouracil (5-FU), gemcitabine, idosfamide, Interferon alfa-2b, methotrexate, mitomycin, nab-paclitaxel, paclitaxel, pemetrexed, thiotepa, vinblastine, and any combination thereof.
• the additional therapeutic agents are suitable for treating breast cancer, which include albumin-bound paclitaxel, anastrozole, capecitabine, carboplatin, cisplatin, cyclophosphamide, docetaxel, doxorubicin, epirubicin, everolimus, exemestane, fluorouracil, fulvestrant, gemcitabine, Ixabepilone, lapatinib, Letrozole, methotrexate, mitoxantrone, paclitaxel, pegylated liposomal doxorubicin, pertuzumab, tamoxifen, toremifene, trastuzumab, vinorelbine, and any combinations thereof.
• the additional therapeutic agents are suitable for treating triple negative breast cancer, which include cyclophosphamide, docetaxel, doxorubicin, epirubicin, fluorouracil, paclitaxel, and combinations thereof.
• the additional therapeutic agents are suitable for treating colorectal cancer, which include bevacizumab, capecitabine, cetuximab, fluorouracil, irinotecan, leucovorin, oxaliplatin, panitumumab, ziv-aflibercept, and any combinations thereof.
• the additional therapeutic agents are suitable for treating castration-resistant prostate cancer, which include abiraterone, cabazitaxel, docetaxel, enzalutamide, prednisone, sipuleucel-T, and any combinations thereof.
• the additional therapeutic agents are suitable for treating esophageal and esophagogastric junction cancer, which include capecitabine, carboplatin, cisplatin, docetaxel, epirubicin, fluoropyrimidine, fluorouracil, irinotecan, leucovorin, oxaliplatin, paclitaxel, ramucirunab, trastuzumab, and any combinations thereof.
• the additional therapeutic agents are suitable for treating gastric cancer, which include capecitabine, carboplatin, cisplatin, docetaxel, epirubicin, fluoropyrimidine, fluorouracil, Irinotecan, leucovorin, mitomycin, oxaliplatin, paclitaxel, ramucirumab, trastuzumab, and any combinations thereof.
• the additional therapeutic agents are suitable for treating head & neck cancer, which include afatinib, bleomycin, capecitabine, carboplatin, cetuximab, cisplatin, docetaxel, fluorouracil, gemcitabine, hydroxyurea, methotrexate, nivolumab, paclitaxel, pembrolizumab, vinorelbine, and any combinations thereof.
• the additional therapeutic agents are suitable for treating hepatobiliary cancer, which include capecitabine, cisplatin, fluoropyrimidine, 5-fluorourcil, gemecitabine, oxaliplatin, sorafenib, and any combinations thereof.
• the additional therapeutic agents are suitable for treating hepatocellular carcinoma, which include capecitabine, doxorubicin, gemcitabine, sorafenib, and any combinations thereof.
• the additional therapeutic agents are suitable for treating non-small cell lung cancer (NSCLC), which include afatinib, albumin-bound paclitaxel, alectinib, bevacizumab, bevacizumab, cabozantinib, carboplatin, cisplatin, crizotinib, dabrafenib, docetaxel, erlotinib, etoposide, gemcitabine, nivolumab, paclitaxel, pembrolizumab, pemetrexed, ramucirumab, trametinib, trastuzumab, vandetanib, vemurafenib, vinblastine, vinorelbine, and any combinations thereof.
• NSCLC non-small cell lung cancer
• the additional therapeutic agents are suitable for treating small cell lung cancer (SCLC), which include bendamustime, carboplatin, cisplatin, cyclophosphamide, docetaxel, doxorubicin, etoposide, gemcitabine, ipillimumab, irinotecan, nivolumab, paclitaxel, temozolomide, topotecan, vincristine, vinorelbine, and any combinations thereof.
• SCLC small cell lung cancer
• the additional therapeutic agents are suitable for treating melanoma, which include albumin bound paclitaxel, carboplatin, cisplatin, cobiemtinib, dabrafenib, dacrabazine, IL-2, imatinib, interferon alfa-2b, ipilimumab, nitrosourea, nivolumab, paclitaxel, pembrolizumab, pilimumab, temozolomide, trametinib, vemurafenib, vinblastine, and any combinations thereof.
• melanoma which include albumin bound paclitaxel, carboplatin, cisplatin, cobiemtinib, dabrafenib, dacrabazine, IL-2, imatinib, interferon alfa-2b, ipilimumab, nitrosourea, nivolumab, paclitaxel, pembroli
• the additional therapeutic agents are suitable for treating ovarian cancer, which include 5-flourouracil, albumin bound paclitaxel, altretamine, anastrozole, bevacizumab, capecitabine, carboplatin, cisplatin, cyclophosphamide, docetaxel, doxorubicin, etoposide, exemestane, gemcibabine, ifosfamide, irinotecan, letrozole, leuprolide acetate, liposomal doxorubicin, megestrol acetate, melphalan, olaparib, oxaliplatin, paclitaxel, Pazopanib, pemetrexed, tamoxifen, topotecan, vinorelbine, and any combinations thereof.
• the additional therapeutic agents are suitable for treating pancreatic cancer, which include 5-fluorourcil, albumin-bound paclitaxel, capecitabine, cisplatin, docetaxel, erlotinib, fluoropyrimidine, gemcitabine, irinotecan, leucovorin, oxaliplatin, paclitaxel, and any combinations thereof.
• the additional therapeutic agents are suitable for treating renal cell carcinoma, which include axitinib, bevacizumab, cabozantinib, erlotinib, everolimus, levantinib, nivolumab, pazopanib, sorafenib, sunitinib, temsirolimus, and any combinations thereof.
• the present disclosure provides a kit comprising a compound of the present disclosure or a pharmaceutically acceptable salt thereof.
• the kit may further comprise instructions for use, e.g., for use in treating a viral infection.
• the instructions for use are generally written instructions, although electronic storage media (e.g., magnetic diskette or optical disk) containing instructions are also acceptable.
• kits comprising one or more containers comprising a compound of the present disclosure or a pharmaceutically acceptable salt thereof.
• Optionally associated with such container(s) can be a notice in the form prescribed by a governmental agency regulating the manufacture, use or sale of pharmaceuticals, which notice reflects approval by the agency for the manufacture, use or sale for human administration.
• Each component if there is more than one component
• kits may be in unit dosage forms, bulk packages (e.g., multi-dose packages) or sub-unit doses. Kits may also include multiple unit doses of the compounds and instructions for use and be packaged in quantities sufficient for storage and use in pharmacies (e.g., hospital pharmacies and compounding pharmacies).
• articles of manufacture comprising a unit dosage of a compound of the present disclosure or a pharmaceutically acceptable salt thereof, in suitable packaging for use in the methods described herein.
• suitable packaging is known in the art and includes, for example, vials, vessels, ampules, bottles, jars, flexible packaging and the like.
• An article of manufacture may further be sterilized and/or sealed.
• the embodiments are also directed to processes and intermediates useful for preparing the subject compounds or pharmaceutically acceptable salts thereof.
• Compounds as described herein can be purified by any of the means known in the art, including chromatographic means, such as high performance liquid chromatography (HPLC), preparative thin layer chromatography, flash column chromatography and ion exchange chromatography. Any suitable stationary phase can be used, including normal and reversed phases as well as ionic resins. Most typically the disclosed compounds are purified via silica gel and/or alumina chromatography. See, e.g., Introduction to Modern Liquid Chromatography, 2nd ed., ed. L. R. Snyder and J. J. Kirkland, John Wiley and Sons, 1979; and Thin Layer Chromatography, E. Stahl (ed.), Springer-Verlag, New York, 1969.
• HPLC high performance liquid chromatography
• Any suitable stationary phase can be used, including normal and reversed phases as well as ionic resins.
• Most typically the disclosed compounds are purified via silica gel and/or alumina chromatography. See, e.g.,
• any of the processes for preparation of the subject compounds it may be necessary and/or desirable to protect sensitive or reactive groups on any of the molecules concerned. This may be achieved by means of conventional protecting groups as described in standard works, such as T. W. Greene and P. G. M. Wuts, “Protective Groups in Organic Synthesis,” 4th ed., Wiley, New York 2006.
• the protecting groups may be removed at a convenient subsequent stage using methods known from the art.
• the methods of the present disclosure generally provide a specific enantiomer or diastereomer as the desired product, although the stereochemistry of the enantiomer or diastereomer was not determined in all cases.
• the stereochemistry of the specific stereocenter in the enantiomer or diastereomer is not determined, the compound is drawn without showing any stereochemistry at that specific stereocenter even though the compound can be substantially enantiomerically or disatereomerically pure.
• H-phosphinic acid 2 Sodium hydride (900 mg, 22.2 mmol) was added under argon at 4° C. to a stirred solution of Intermediate 1 (5 g, 7.4 mmol) in DMF (75 mL) (Scheme 1). The reaction mixture was stirred for additional 60 min at 4° C. under argon. Tosyl H-phosphinate (3.05 g, 11.1 mmol) was added under argon to the reaction mixture. The reaction mixture was stirred for additional 16 h at room temperature under argon. After that, glacial acetic acid (1.27 mL, 22.2 mmol) in DMF (10 mL) was added dropwise at 4° C. to the reaction mixture and the reaction mixture was evaporated.
• DMOCP 2-Chloro-5,5-dimethyl-1,3,2-dioxaphosphorinane 2-oxide
• DMOCP 2-Chloro-5,5-dimethyl-1,3,2-dioxaphosphorinane 2-oxide
• Phosphonate 4 (1.3 g, 1.5 mmol) was loaded on silica gel column in DCM (10 mL). The column was washed with DCA (10 mL, 3% in DCM) and left for 15 min at r.t. The column was then washed with a mixture of DCA (25 mL, 3% in DCM)/10% EtOH in CHCl 3 (25 mL), and after that with 10% EtOH in CHCl 3 (100 mL).
• Phosphoramidites were prepared using standard protocols according to Páv, O; Ko ⁇ iovà, I.; Barvik, I.; Pohl, R.; Bud ⁇ nsk ⁇ , M.; Rosenberg, I. Synthesis of oligoribonucleotides with phosphonate-modified linkages. Org. Biomol. Chem. 2011, 9, 6120-6126 and Páv, O.; Panova, N.; Sná ⁇ el, J.; Zborniková, E.; Rosenberg I. Activation of human RNase L by 2′- and 5′-O-methylphosphonate-modified oligoadenylates. Boorg. Med. Chem. Lett. 2012, 22, 181-185 (Scheme 2).
• HFIPP Tris(1,1,1,3,3,3-hexafluoro-2-propyl) phosphite
• the diastereomers were converted to sodium salts using DOWEX Na + and freeze-dried from water to give Compound 11a and Compound 11b.
• DMOCP 5,5-Dimethyl-2-oxo-2-chloro-1,3,2-dioxaphosphinane
• the diastereomers were converted to sodium salts using DOWEX Na + and freeze-dried from water to give Compound 13a and Compound 13b.
• the diastereomers were converted to sodium salts using DOWEX Na + and freeze-dried from water to give Compound 15a and Compound 15b.
• the diastereomers were converted to sodium salts using DOWEX Na + and freeze-dried from water to provide Compound 17a, Compound 17c, and Compound 17d.
• Preparative HPLC conditions used for purification were as follows: Luna C18 (15 pm, 200 ⁇ 40 mm, Phenomenex); flow 20 mL/min; mobile phase A: 5 mM ammonium bicarbonate in H 2 O, mobile phase B: ACN.
• HPLC Method isocratic elution with water (10 min), then isocratic elution with A (10 min) and then linear gradient A—75% B (60 min).
• the fractions containing the nucleobase-protected CDN were evaporated and treated with a mixture of aqueous ammonia/ethanol 3:1 for 16 h at room temperature. The mixture was evaporated and Compound 21 was isolated using preparative C18 HPLC.
• HPLC conditions used for purification were as follows: Luna C18 (5 pm, 250 ⁇ 21.2 mm, Phenomenex); flow 10 mL/min; mobile phase A: 0.1M TEAB/H 2 O, mobile phase B: 50% ACN/0.1M TEAB/H 2 O.
• HPLC Method isocratic elution A (10 min), then linear gradient A—B (50 min), retention time (min): 51.4.
• Phosphonate 4 (2.2 g; 2.5 mmol) was dissolved in methanol (20 mL) and was treated with 33% MeNH 2 in ethanol (10 mL) for 2 h at room temperature (Scheme 9). The reaction mixture was concentrated and coevaporated with pyridine (30 mL). The residue was dissolved in pyridine and 4-pentenoic anhydride (1.8 mL; 10 mmol) and DMAP (76 mg; 0.5 mmol) were added. The reaction mixture was stirred for 24 h at 50° C., whereupon water (10 mL) was added, and the heating continued for 3 h at 60° C. The reaction mixture was concentrated.
• TBDMS-Cl (0.7 g; 4.5 mmol) was added to a solution of Intermediate 24 (2.0 g; 3.0 mmol; Carbosynth, cat. #NB63548) and imidazole (0.3 g; 4.5 mmol) in DMF (30 mL) (Scheme 10).
• the reaction mixture was stirred for 16 h at room temperature, and then quenched by the addition of methanol (5 mL).
• the mixture was concentrated, then diluted with DCM (300 mL), washed with saturated solution of sodium bicarbonate (3 ⁇ 100 ml), and evaporated. The residue was dissolved in methanol (20 mL) and was treated with 33% MeNH 2 in ethanol (10 mL) for 2 h at room temperature.
• the reaction mixture was evaporated and coevaporated with pyridine.
• the residue was dissolved in pyridine (30 mL) and 4-pentenoic anhydride (2.3 mL; 12 mmol) and DMAP (91 mg; 0.6 mmol) were added.
• the reaction mixture was stirred for 24 h at 50° C. After that, water (10 mL) was added and the heating continued for 3 h at 60° C.
• the reaction mixture was evaporated and the residue was dissolved in chloroform (0.5 L), and washed with 10% citric acid (3 ⁇ 100 ml), and then with 0.2 M TEAB (3 ⁇ 100 ml).
• the organic layer was dried over anhydrous sodium sulfate, evaporated and coevaporated with toluene.
• Cyclic dinucleotide (1 ⁇ mol, Et 3 NH + or Na + salt) in 50% aqueous ACN (800 ⁇ L) was treated with a suitable alkyl iodide (10 ⁇ mol diluted in 10 ⁇ L of ACN) at room temperature overnight to form the corresponding prodrug.
• alkyl iodides were prepared according to literature methods: benzyl-type alkyl iodides were prepared according to Gollnest, T. et al Nat. Commun. 2015, 6:8716 and Alvarez-Manzaneda, E. J. et al Tetrahedron Lett.
• Cyclic dinucleotide (1 ⁇ mol, Et 3 NH + or Na + salt) in 80% aqueous ACN (800 ⁇ L) was treated with a suitable alkyl iodide (10 ⁇ mol diluted in 10 ⁇ L of DMF) at room temperature overnight to form the corresponding prodrug.
• the reaction mixture was diluted with water (3 mL) and directly applied to HPLC column and purified using HPLC method 2. Fractions containing the product were freeze dried.
• Cyclic dinucleotide (1 ⁇ mol, Et 3 NH + or Na + salt) in 50% aqueous ACN (800 ⁇ L) was treated with alkyl iodide (10 ⁇ mol diluted in 10 ⁇ L of ACN) at room temperature overnight.
• the reaction mixture was diluted with water (2 mL) and directly applied to HPLC column and purified using HPLC method 3. Fractions containing the product were freeze dried.
• Cyclic dinucleotide (1 ⁇ mol, Et 3 NH + ) was dissolved in methanol (200 ⁇ L) and passed through a column of DOWEX 50 tetrabutylammonium salt (1 mL). The resin was washed with methanol (3 ⁇ 1 mL) and solutions were evaporated. The residue was coevaporated with dioxane (3 ⁇ 1 mL) and acetonitrile (3 ⁇ 1 mL). The residue was dissolved in ACN (0.5 mL), suitable alkyl iodide (10 ⁇ mol diluted in 10 ⁇ L of ACN) was added and the reaction mixture was shaken at room temperature for 2 h at room temperature. The reaction mixture was diluted with water (3 mL) and directly applied to HPLC column and purified using HPLC method 10. Fractions containing the product were collected and freeze dried.
• reaction mixture was quenched by the addition of a saturated solution of Na 2 S 2 O 3 *5H 2 O in water (200 ⁇ L), diluted with 50% ACN in water (3 mL) and directly purified by HPLC using HPLC method 12. Fractions containing the product were collected, evaporated and coevaporated with ACN.
• Precursor Compound Prodrug Compound(s) 11a 31a, 32a, 33a, 34a, 35a, 36a, 37a, 38a, 39a, 40a, and 57a 11b 31b, 32b, 33b, 34b, 35b, 36b, 37b, 38b, 39b, 40b, 57b, 59b, 60b, and 62b 15a 41a, 42a, 43a, 44a, 45a, 46a, 47a, 48a, 49a, and 76a 15b 41b, 42b, 43b, 44b, 45b, 46b, 47b, 48b, 49b, and 76b 13a 50a, 51a, 56a, 64a, 68a, and 75a 13b 50b, 51b, 56b, 58b, 61b, 63b, 64b, 65b, 66b, 67b, 68b, 70b, 71b, and 72b 17c 52c, 55c, 69c and 78c 17d 55d and
• 32a 823.2/ 823.4 32a: ⁇ [(1S,6R,8R,9R,10R,16R,18R,19R)-18-(2-amino-6-oxo-6,9-dihydro-1H-purin-9-yl)- 8-(6-amino-9H-purin-9-yl)-9,19-difluoro-13-hydroxy-3,13-dioxo-2,4,7,11,14,17-hexaoxa- 3 ⁇ 5 ,13 ⁇ 5 -diphosphatricyclo[14.2.1.0 6,10 ]nonadecan-3-yl]sulfanyl ⁇ methyl 2,2- dimethylpropanoate prepared using Method A, purified using HPLC Method 1, retention time (min) 25.4; 1 H NMR (DMSO-d 6 ) ⁇ 10.66 (br s, 1H), 8.24 (s, 1H), 8.17 (s,1H), 8.04 (br s, 1H), 7.40 (b
• 32b 823.2/ 823.5 32b: ⁇ [(1S,6R,8R,9R,10R,16R,18R,19R)-18-(2-amino-6-oxo-6,9-dihydro-1H-purin-9-yl)- 8-(6-amino-9H-purin-9-yl)-9,19-difluoro-13-hydroxy-3,13-dioxo-2,4,7,11,14,17-hexaoxa- 3 ⁇ 5 ,13 ⁇ 5 -diphosphatricyclo[14.2.1.0 6,10 ]nonadecan-3-yl]sulfanyl ⁇ methyl 2,2- dimethylpropanoate prepared using Method A, purified using HPLC Method 1, retention time (min) 28.0; 1 H NMR (DMSO-d 6 ) ⁇ 10.73 (br s, 1H), 8.28 (s, 1H), 8.18 (s, 1H), 8.01 (s, 1H), 7.42 (br s
• 34b 941.2/ 941.6 34b: 4-( ⁇ [(1S,6R,8R,9R,10R,16R,18R,19R)-18-(2-amino-6-oxo-6,9-dihydro-1H-purin-9- yl)-8-(6-amino-9H-purin-9-yl)-9,19-difluoro-13-hydroxy-3,13-dioxo-2,4,7,11,14,17- hexaoxa-3 ⁇ 5 ,13 ⁇ 5 -diphosphatricyclo[14.2.1.0 6,10 ]nonadecan-3-yl]sulfanyl ⁇ methyl)phenyl octanoate prepared using Method C, purified using HPLC Method 3, retention time (min) 43.9; 1 H NMR (DMSO-d 6 ) ⁇ 10.63 (br s, 1H), 8.24 (s, 1H), 8.17 (s, 1H) 8.08 (s, 1H), 7.40 (
• 35a 969.3/ 969.7 35a: 4-( ⁇ [(1S,6R,8R,9R,10R,16R,18R,19R)-18-(2-amino-6-oxo-6,9-dihydro-1H-purin-9- yl)-8-(6-amino-9H-purin-9-yl)-9,19-difluoro-13-hydroxy-3,13-dioxo-2,4,7,11,14,17- hexaoxa-3 ⁇ 5 ,13 ⁇ 5 -diphosphatricyclo[14.2.1.0 6,10 ]nonadecan-3-yl]sulfanyl ⁇ methyl)phenyl decanoate prepared using Method B, purified using HPLC Method 2, retention time (min) 25.4; 1 H NMR (DMSO-d 6 ) ⁇ 10.65 (br s, 1H), 8.23 (br s, 1H), 8.16 (s, 1H), 8.11 (s, 1H), 7.40
• 36a 885.2/ 885.6 36a: 4-( ⁇ [(1S,6R,8R,9R,10R,16R,18R,19R)-18-(2-amino-6-oxo-6,9-dihydro-1H-purin-9- yl)-8-(6-amino-9H-purin-9-yl)-9,19-difluoro-13-hydroxy-3,13-dioxo-2,4,7,11,14,17- hexaoxa-3 ⁇ 5 ,13 ⁇ 5 -diphosphatricyclo[14.2.1.0 6,10 ]nonadecan-3-yl]sulfanyl ⁇ methyl)phenyl butanoate prepared using Method C, purified using HPLC Method 3, retention time (min) 32.5; 1 H NMR (DMSO-d 6 ) ⁇ 10.63 (br s, 1H), 8.23 (br s, 1H), 8.19 (br s, 1H), 8.11 (s, 1H),
• 36b 882.2/ 885.6 36b: 4-( ⁇ [(1S,6R,8R,9R,10R,16R,18R,19R)-18-(2-amino-6-oxo-6,9-dihydro-1H-purin-9- yl)-8-(6-amino-9H-purin-9-yl)-9,19-difluoro-13-hydroxy-3,13-dioxo-2,4,7,11,14,17- hexaoxa-3 ⁇ 5 ,13 ⁇ 5 -diphosphatricyclo[14.2.1.0 6,10 ]nonadecan-3-yl]sulfanyl ⁇ methyl)phenyl butanoate prepared using Method C, purified using HPLC Method 3, retention time (min) 35.6; 1 H NMR (DMSO-d 6 ) ⁇ 10.61 (br s, 1H), 8.23 (s, 1H), 8.17 (s, 1H), 8.08 (s, 1H), 7.37 (br
• 38b 997.3/ 997.8 38b: 4-( ⁇ [(1S,6R,8R,9R,10R,16R,18R,19R)-18-(2-amino-6-oxo-6,9-dihydro-1H-purin-9- yl)-8-(6-amino-9H-purin-9-yl)-9,19-difluoro-13-hydroxy-3,13-dioxo-2,4,7,11,14,17- hexaoxa-3 ⁇ 5 ,13 ⁇ 5 -diphosphatricyclo[14.2.1.0 6,10 ]nonadecan-3-yl]sulfanyl ⁇ methyl)phenyl dodecanoate prepared using Method D, purified using HPLC Method 4, retention time (min) 34.5; 1 H NMR (DMSO-d 6 ) ⁇ 10.66 (br s, 1H), 8.23 (s, 1H), 8.17 (s, 1H), 8.08 (s, 1H), 7.38 (br
• 39b 929.2/ 929.5 39b: [4-( ⁇ [(1S,6R,8R,9R,10R,16R,18R,19R)-18-(2-amino-6-oxo-6,9-dihydro-1H-purin-9- yl)-8-(6-amino-9H-purin-9-yl)-9,19-difluoro-13-hydroxy-3,13-dioxo-2,4,7,11,14,17- hexaoxa-3 ⁇ 5 ,13 ⁇ 5 -diphosphatricyclo[14.2.1.0 6,10 ]nonadecan-3- yl]sulfanyl ⁇ methyl)phenoxy]methyl 2,2-dimethylpropanoate prepared using Method A purified using HPLC Method 1, retention time (min) 33.8; 1 H NMR (DMSO-d 6 ) ⁇ 10.64 (br s, 1H), 8.25 (s, 1H), 8.17 (s, 1H), 8.09 (s, 1
• 40a 1033.2/ 1033.5 40a: 4-( ⁇ [(1S,6R,8R,9R,10R,16R,18R,19R)-18-(2-amino-6-oxo-6,9-dihydro-1H-purin-9- yl)-8-(6-amino-9H-purin-9-yl)-9,19-difluoro-13-hydroxy-3,13-dioxo-2,4,7,11,14,17- hexaoxa-3 ⁇ 5 ,13 ⁇ 5 -diphosphatricyclo[14.2.1.0 6,10 ]nonadecan-3-yl]sulfanyl ⁇ methyl)phenyl 4-(hexanoyloxy)benzoate prepared using Method B, purified using HPLC Method 2, retention time (min) 23.8; 1 H NMR (DMSO-d 6 ) ⁇ 10.65 (br s, 1H), 8.28-8.10 (m, 5H), 7.36 (m, 2H), 7.09
• 41a 823.2/ 823.2 41a: ⁇ [(1S,6R,8R,9R,10R,16R,18R,19R)-18-(2-amino-6-oxo-6,9-dihydro-1H-purin-9- yl)-8-(6-amino-9H-purin-9-yl)-9,19-difluoro-3-hydroxy-3,13-dioxo-2,4,7,11,14,17- hexaoxa-3 ⁇ 5 ,13 ⁇ 5 -diphosphatricyclo[14.2.1.0 6,10 ]nonadecan-13-yl]sulfanyl ⁇ methyl 2,2- dimethylpropanoate prepared using Method A, purified using HPLC Method 1, retention time (min) 29.2; 1 H NMR (DMSO-d 6 ) ⁇ 10.71 (br s, 1H), 8.35 (s, 1H), 8.19 (s, 1H), 7.94 (s, 1H), 7.50 (br
• 41b 823.2/ 823.5 41b: ⁇ [(1S,6R,8R,9R,10R,16R,18R,19R)-18-(2-amino-6-oxo-6,9-dihydro-1H-purin-9- yl)-8-(6-amino-9H-purin-9-yl)-9,19-difluoro-3-hydroxy-3,13-dioxo-2,4,7,11,14,17-hexaoxa- 3 ⁇ 5 ,13 ⁇ 5 -diphosphatricyclo[14.2.1.0 6,10 ]nonadecan-13-yl]sulfanyl ⁇ methyl 2,2- dimethylpropanoate prepared using Method A, purified using HPLC Method 1 retention time (min) 30.8; 1 H NMR (DMSO-d 6 ) ⁇ 10.70 (br s, 1H), 8.34 (s, 1H), 8.19 (s, 1H), 8.01 (s, 1H), 7.40 (br s
• 42a 913.2/ 913.5 42a: 4-( ⁇ [(1S,6R,8R,9R,10R,16R,18R,19R)-18-(2-amino-6-oxo-6,9-dihydro-1H-purin-9- yl)-8-(6-amino-9H-purin-9-yl)-9,19-difluoro-3-hydroxy-3,13-dioxo-2,4,7,11,14,17- hexaoxa-3 ⁇ 5 ,13 ⁇ 5 -diphosphatricyclo[14.2.1.0 6,10 ]nonadecan-13-yl]sulfanyl ⁇ methyl)phenyl hexanoate prepared using Method C, purified using HPLC Method 3, retention time (min) 36.0; 31 P NMR (DMSO-d 6 ) ⁇ 47.64 (s, 1P), 0.38 (s, 1P); 19 F NMR (DMSO-d 6 ) ⁇ ⁇ 190.19 (dt
• 45b 941.2/ 941.6 45b: 4-( ⁇ [(1S,6R,8R,9R,10R,16R,18R,19R)-18-(2-amino-6-oxo-6,9-dihydro-1H-purin-9- yl)-8-(6-amino-9H-purin-9-yl)-9,19-difluoro-3-hydroxy-3,13-dioxo-2,4,7,11,14,17- hexaoxa-3 ⁇ 5 ,13 ⁇ 5 -diphosphatricyclo[14.2.1.0 6,10 ]nonadecan-13-yl]sulfanyl ⁇ methyl)phenyl octanoate prepared using Method C, purified using HPLC Method 3, retention time (min) 31.9; 1 H NMR (DMSO-d 6 ) ⁇ 10.68 (br s, 1H), 8.33 (s, 1H), 8.20 (s, 1H), 8.03 (s, 1H), 7.45 (
• 48a 885.2/ 885.4 48a: 4-( ⁇ [(1S,6R,8R,9R,10R,16R,18R,19R)-18-(2-amino-6-oxo-6,9-dihydro-1H-purin-9- yl)-8-(6-amino-9H-purin-9-yl)-9,19-difluoro-3-hydroxy-3,13-dioxo-2,4,7,11,14,17- hexaoxa-3 ⁇ 5 ,13 ⁇ 5 -diphosphatricyclo[14.2.1.0 6,10 ]nonadecan-13-yl]sulfanyl ⁇ methyl)phenyl butanoate prepared using Method C, purified using HPLC Method 3, retention time (min) 34.0; 1 H NMR (DMSO-d 6 ) ⁇ 10.64 (br s, 1H), 8.35 (s, 1H), 8.20 (s, 1H), 8.00 (s, 1H), 7.43 (br
• 48b 885.2/ 885.4 48b: 4-( ⁇ [(1S,6R,8R,9R,10R,16R,18R,19R)-18-(2-amino-6-oxo-6,9-dihydro-1H-purin-9- yl)-8-(6-amino-9H-purin-9-yl)-9,19-difluoro-3-hydroxy-3,13-dioxo-2,4,7,11,14,17- hexaoxa-3 ⁇ 5 ,13 ⁇ 5 -diphosphatricyclo[14.2.1.0 6,10 ]nonadecan-13-yl]sulfanyl ⁇ methyl)phenyl butanoate prepared using Method C, purified using HPLC Method 3, retention time (min) 41.0; 31 P NMR (DMSO-d 6 ) ⁇ 49.19 (br s, 1P), 0.07 (br s, 1P); 19 F NMR (DMSO-d 6 ) ⁇ ⁇ 191.1
• 49a 1033.2/ 1033.6 49a: 4-( ⁇ [(1S,6R,8R,9R,10R,16R,18R,19R)-18-(2-amino-6-oxo-6,9-dihydro-1H-purin-9- yl)-8-(6-amino-9H-purin-9-yl)-9,19-difluoro-3-hydroxy-3,13-dioxo-2,4,7,11,14,17- hexaoxa-3 ⁇ 5 ,13 ⁇ 5 -diphosphatricyclo[14.2.1.0 6,10 ]nonadecan-13-yl]sulfanyl ⁇ methyl)phenyl 4-(hexanoyloxy)benzoate prepared using Method D, purified using HPLC Method 3, retention time (min) 24.6; 31 P NMR (DMSO-d 6 ) ⁇ 46.53 (s, 1P), ⁇ 0.94 (s, 1P); 19 F NMR (DMSO-d 6 )
• 49b 1033.2/ 1033.5 49b: 4-( ⁇ [(1S,6R,8R,9R,10R,16R,18R,19R)-18-(2-amino-6-oxo-6,9-dihydro-1H-purin-9- yl)-8-(6-amino-9H-purin-9-yl)-9,19-difluoro-3-hydroxy-3,13-dioxo-2,4,7,11,14,17- hexaoxa-3 ⁇ 5 ,13 ⁇ 5 -diphosphatricyclo[14.2.1.0 6,10 ]nonadecan-13-yl]sulfanyl ⁇ methyl)phenyl 4-(hexanoyloxy)benzoate prepared using Method D, purified using HPLC Method 4, retention time (min) 26.2; 31 P NMR (DMSO-d 6 ) ⁇ 48.09 (s, 1P), ⁇ 1.07 (s, 1P); 19 F NMR (DMSO-d 6 )
• 51a 914.2/ 914.5 51a: [4-( ⁇ [(1S,6R,8R,9R,10R,16R,18R,19R)-8-(6-amino-9H-purin-9-yl)-9,19-difluoro-13- hydroxy-3,13-dioxo-18-(6-oxo-6,9-dihydro-1H-purin-9-yl)-2,4,7,11,14,17-hexaoxa- 3 ⁇ 5 ,13 ⁇ 5 -diphosphatricyclo[14.2.1.0 6,10 ]nonadecan-3-yl]sulfanyl ⁇ methyl)phenoxy]methyl 2,2-dimethylpropanoate prepared using Method C, purified using HPLC Method 3, retention time (min) 26.1; 1 H NMR (DMSO-d 6 ) ⁇ 12.50 (br s, 1H), 8.78 (s, 1H), 8.35 (s, 1H), 8.12 (s, 1H), 8.10
• 56a 906.3/ 906.5 56a: ( ⁇ [(1S,6R,8R,9R,10R,16R,18R,19R)-8-(6-amino-9H-purin-9-yl)-9,19-difluoro-13- hydroxy-3,13-dioxo-18-(6-oxo-6,9-dihydro-1H-purin-9-yl)-2,4,7,11,14,17-hexaoxa- 3 ⁇ 5 ,13 ⁇ 5 -diphosphatricyclo[14.2.1.0 6,10 ]nonadecan-3-yl]sulfanyl ⁇ methyl dodecanoate prepared using Method F, purified using HPLC Method 7, retention time (min) 18.85; 1 H NMR (DMSO-d 6 ) ⁇ 12.53 (br s, 1H), 8.73 (s, 1H), 8.25 (s, 1H), 8.16 (s, 1H), 8.12 (s, 1H), 7.40 (br s,
• 61b 958.2/ 958.3 61b: ⁇ [(1S,6R,8R,9R,10R,16R,18R,19R)-8-(6-amino-9H-purin-9-yl)-9,19-difluoro-13- hydroxy-3,13-dioxo-18-(6-oxo-6,9-dihydro-1H-purin-9-yl)-2,4,7,11,14,17-hexaoxa- 3 ⁇ 5 ,13 ⁇ 5 -diphosphatricyclo[14.2.1.0 6,10 ]nonadecan-3-yl]sulfanyl ⁇ methyl 4- ⁇ [(2,2- dimethylpropanoyl)oxy]methoxy ⁇ benzoate prepared using Method B, purified using HPLC Method 2, retention time (min) 19.0; 1 H NMR (DMSO-d 6 ) ⁇ 12.56 (br s, 1H), 8.48 (br s, 1H), 8.26 (s, 1
• 62b 973.2/ 973.4 62b: ⁇ [(1S,6R,8R,9R,10R,16R,18R,19R)-18-(2-amino-6-oxo-6,9-dihydro-1H-purin-9-yl)- 8-(6-amino-9H-purin-9-yl)-9,19-difluoro-13-hydroxy-3,13-dioxo-2,4,7,11,14,17-hexaoxa- 3 ⁇ 5 ,13 ⁇ 5 -diphosphatricyclo[14.2.1.0 6,10 ]nonadecan-3-yl]sulfanyl ⁇ methyl 4- ⁇ [(2,2- dimethylpropanoyl)oxy]methoxy ⁇ benzoate prepared using Method B, purified using HPLC Method 2, retention time (min) 18.9; 1 H NMR (DMSO-d 6 ) ⁇ 10.62 (br s, 1H), 8.29 (br s, 1H), 8.27-8
• 64a 962.3/ 962.5 64a: ⁇ [(1S,6R,8R,9R,10R,16R,18R,19R)-8-(6-amino-9H-purin-9-yl)-9,19-difluoro-13- hydroxy-3,13-dioxo-18-(6-oxo-6,9-dihydro-1H-purin-9-yl)-2,4,7,11,14,17-hexaoxa- 3 ⁇ 5 ,13 ⁇ 5 -diphosphatricyclo[14.2.1.0 6,10 ]nonadecan-3-yl]sulfanyl ⁇ methyl hexadecanoate; prepared using Method F, purified using HPLC Method 9, retention time (min) 27.2; 1 H NMR (DMSO-d 6 ) ⁇ 12.61 (br s, 1H), 8.37 (br s, 1H), 8.25 (s, 1H), 8.17 (s, 1H), 7.48 (br s
• 66b 990.3/ 990.5 66b: ⁇ [(1S,6R,8R,9R,10R,16R,18R,19R)-8-(6-amino-9H-purin-9-yl)-9,19-difluoro-13- hydroxy-3,13-dioxo-18-(6-oxo-6,9-dihydro-1H-purin-9-yl)-2,4,7,11,14,17-hexaoxa- 3 ⁇ 5 ,13 ⁇ 5 -diphosphatricyclo[14.2.1.0 6,10 ]nonadecan-3-yl]sulfanyl ⁇ methyl octadecanoate prepared using Method F, purified using HPLC Method 7, retention time (min) 22.2; HRMS for C 40 H 60 O 12 N 9 F 2 P 2 S calcd.
• 80c 909.2/ 909.2 80c: ⁇ [(1S,6R,8R,9R,10R,16R,18R,19R)-8,18-bis(6-amino-9H-purin-9-yl)-9,19-difluoro- 3,13-dioxo-13-( ⁇ [(propan-2-yloxy)carbonyl]oxy ⁇ methoxy)-2,4,7,11,14,17-hexaoxa- 3 ⁇ 5 ,13 ⁇ 5 -diphosphatricyclo[14.2.1.0 6,10 ]nonadecan-3-yl]oxy ⁇ methyl propan-2-yl carbonate Prepared using Method J, purified by HPLC Method 11, retention time (min) 50; 1 H NMR (DMSO-d 6 ) ⁇ 8.37 (s, 1H), 8.34 (s, 1H), 8.24 (s, 1H), 8.17 (s, 1H), 7.45 (br s, 2H), 7.39 (br s, 2H),
• 81a 905.3/ 905.3 81a ⁇ [(1S,6R,8R,9R,10R,16R,18R,19R)-8,18-bis(6-amino-9H-purin-9-yl)-13- ⁇ [(2,2- dimethylpropanoyl)oxy]methoxy ⁇ -9,19-difluoro-3,13-dioxo-2,4,7,11,14,17-hexaoxa- 3 ⁇ 5 ,13 ⁇ 5 -diphosphatricyclo[14.2.1.0 6,10 ]nonadecan-3-yl]oxy ⁇ methyl 2,2- dimethylpropanoate.
• 81b 905.3/ 905.3 81b ⁇ [(1S,6R,8R,9R,10R,16R,18R,19R)-8,18-bis(6-amino-9H-purin-9-yl)-13- ⁇ [(2,2- dimethylpropanoyl)oxy]methoxy ⁇ -9,19-difluoro-3,13-dioxo-2,4,7,11,14,17-hexaoxa- 3 ⁇ 5 ,13 ⁇ 5 -diphosphatricyclo[14.2.1.0 6,10 ]nonadecan-3-yl]oxy ⁇ methyl 2,2- dimethylpropanoate.
• a cyclic dinucleotide was determined to be a STING agonist: (A) if it demonstrated binding to the AQ allelic form of human STING protein with thermal shift of >0.5° C. in the STING Differential Scanning Fluorimetry Assay (DSF), and (B) if it demonstrated STING activation in any one of the following cell assays with EC 50 ⁇ 100 ⁇ mol ⁇ l ⁇ 1 .
• Two complementary oligonucleotides of the sequence AAAGATCTTGGAAAGTGAAACCMTGGAAAACGAAACTGGACAAAGGGAAACTG CAGAAACTGAAACAAAGCTTAA (SEQ ID NO:1) and TTAAGCTTTGTTTCAGTTTCTGCAGTTTCCCTTTGTCCAGTTTCGTTTTCCAAGGTT TCACTTCCAAGATCTTT (SEQ ID NO:2) containing four interferon-sensitive response elements (ISRE) were synthesized by Sigma Aldrich (Czech Republic, Prague).
• the oligonucleotides were mixed in equal molar amounts, hybridized, and cleaved by restriction endonucleases HindIII (cat. #.
• 293T cells (cat. #CRL-3216, ATCC, Manassas, USA) were seeded a day before transfection at density 125,000 cells per cm 2 onto poly-D-lysine (cat. #P6407, Sigma Aldrich, Czech Republic) coated six well plates in antibiotic free DMEM with high glucose (cat. #D5796, Sigma Aldrich, Czech Republic) supplemented with 10% heat inactivated FBS (cat. #S1520, Biowest, Riverside, USA). On the day of transfection, 2.5 pg of the plasmid pUNO1-hSTING-WT (cat.
• WT STING human wild type STING
• OptiMEM medium cat. #31985062, ThermoFisher, Waltham, USA
• Lipofectamine 2000 cat. #11668019, ThermoFisher, Waltham, USA
• RT room temperature
• 250 ⁇ L of the mixture was added dropwise to the cells in one well.
• Cells were incubated 36 hours at 37° C. with 5% CO 2 , and then detached with 0.05% Trypsin and 0.22 g/L EDTA (both cat. #L0941, Biowest, Riverside, USA).
• Transfected cells were seeded onto poly-D-lysine coated six well plates at density 50,000 cells per 1 cm 2 in DMEM medium with high glucose containing 10% heat inactivated FBS, 30 ⁇ g/mL blasticidin (cat. #ant-bl-05, InvivoGen, San Diego, USA), 0.06 mg/ml Penicillin G and 0.1 mg/ml Streptomycin Sulfate (both cat. #. L0018, Biowest, Riverside, USA). The medium was replenished every 3-4 days until visible colonies of cells resistant to blasticidin were formed.
• Blasticidin resistant cells stably expressing WT STING were further transfected with pGL64.27-4 ⁇ ISRE plasmid following the same procedure as described above.
• the transfected cells were selected for the resistance to 300 pg/mL hygromycin (cat. #. 10687010, ThermoFisher, Waltham, USA) in DMEM with high glucose containing 10% heat inactivated FBS, 30 ⁇ g/mL blasticidin, 0.06 mg/ml Penicillin G and 0.1 mg/ml Streptomycin Sulfate.
• Homogeneous culture of stably double transfected cells was prepared by limiting dilution of cells in 96 well plates and wells with cells were selected that originated from a single cell.
• Genomic DNA from the transfected cells was amplified with primers pUNO1_Seq_F (TGCTTGCTCAACTCTACGTC) (SEQ ID NO:3) and pUNO1_Seq_R (GTGGTITGTCCAAACTCATC) (SEQ ID NO:4) that were complementary to pUNO1 plasmid and the presence of WT STING gene in the transfected cells was confirmed by DNA sequencing.
• 293T wtSTING-FL cells were seeded at density of 250,000 cells per cm 2 onto 96 well poly-D-lysine coated plates in 100 ⁇ l DMEM with high glucose supplemented with 10% heat inactivated FBS. The medium was removed next day and three fold serial dilutions of compounds in Digitonin buffer containing 50 mmol ⁇ l ⁇ 1 HEPES (cat. #H3375, Sigma Aldrich, Czech Republic) pH 7.0, 100 mmol ⁇ l ⁇ 1 KCl, 3 mmol ⁇ l ⁇ 1 MgCl 2 , 0.1 mmol ⁇ l ⁇ 1 DTT (cat. #D0632, Sigma Aldrich, Czech Republic), 85 mmol ⁇ l ⁇ 1 Sucrose (cat.
• #tlrl-nacga), 2′3′-cGAMP (cat. #tlrl-nacga23), and 2′2′-cGAMP (cat. #tlrl-nacga22) were purchased from Invivogen (San Diego, USA).
• Both WT and AQ human STING (G230A-R293Q) cDNA were amplified by the use of PCR (Phusion® High-Fidelity DNA Polymerase, cat. #M0530S, NEB, Ipswich, USA) using oligonucleotides hSTING140-BamH-For (GTGGGATCCGCCCCAGCTGAGATCTCTGCAG) (SEQ ID NO:5) and hSTING379-Not-Rev3 (TATGCGGCCGCCTATTACACAGTAACCTCTTCCITITC) (SEQ ID NO:6) from pUNO1-hSTING-WT (cat.
• Plasmid pSUMO was created by introducing 8-His-SUMO sequence between NdeI and BamHI sites of pHis-parallel2 plasmid (Clontech, Mountain View, USA).
• pSUMO-STING WT or pSUMO-STING AQ plasmids thus encoded truncated human WT STING or AQ STING (amino acid residues 140-343) with N-terminal 8 ⁇ His and SUMO tag.
• the eluted proteins were cleaved with recombinant SUMO protease (80 pg/ml of protein solution, cat. #12588018, ThermoFisher, Waltham, USA).
• the proteins were further purified by size exclusion chromatography using HiLoad 16/60 Superdex 75 (cat. #28989333, GE Healthcare Bio-Sciences, Pittsburgh, USA) in 50 mmol ⁇ l ⁇ 1 Tris Cl buffer pH 7.4 containing 150 mmol ⁇ l ⁇ 1 NaCl, and 10% glycerol. Proteins were concentrated with Amicon® Ultra-15 10 K device (cat. #UFC901008, Merck Millipore, Billerica, USA) and flash frozen in liquid N 2 .
• Amino acid sequence of 8-His-SUMO (SEQ ID NO: 8) MSHHEIREIRRHGMSDSEVNQEAKPEVKPEVKPETHINLKVSDGSSEIF FKIKKTTPLRRLMEAFAKRQGKEMDSLRFLYDGIRIQADQTPEDLDMED NDITEAHREQIGGS.
• WT and AQ allelic forms of STING protein were diluted to the final concentration 0.1 mg/ml in 100 mmol ⁇ l ⁇ 1 TrisCl buffer pH 7.4 containing, 150 mmol ⁇ l ⁇ 1 NaCl, 1:500 SYPRO® ⁇ Orange (cat. #S6650, ThermoFisher, Waltham, MA, USA) and 150 ⁇ M CDN or water. 20.L solutions of the reaction mixtures were pipetted in triplicates into 96 well optical reaction plates and thermal denaturation of samples were performed on real time PCR cycler (LightCycler (V 480 Instrument II—Roche, Basel, Switzerland).
• the first derivative of the thermal denaturation curves was performed to calculate denaturing temperatures of STING—CDN complexes and STING apoproteins.
• the thermal shift for each CDN was calculated by subtracting the average denaturing temperature of STING apoprotein from the average denaturing temperature of STING CDN complex.
• 293T wtSTING-FL cells were seeded at density of 250,000 cells per cm z onto 96 well poly-D-lysine coated white micro plates in 100 II DMEM medium with high glucose supplemented with 10% heat inactivated FBS. The medium was removed the next day and three-fold serial dilutions of compounds in 100 ⁇ l medium were added to the cells. The plates were incubated for 7 hours at 37° C. with 5% CO 2 . Next 50 ⁇ l of the medium was removed from wells, and 30 ⁇ l of ONE-GloTM Luciferase Assay System reagent (cat. #E6120, Promega, Madison, WI USA) was added to each well.
• Luminescence was read on Synergy H1 (Biotek, Winooski, VT USA). GraphPad Prism (La Jolla, CA USA) was used to calculate the 50% effective concentration (EC 50 ) from an 8-point dose-response curve.
• Control compounds 3′3′-cGAMP catalog. #tlrl-nacga
• 2′3′-cGAMP catalog. #tlrl-nacga23
• 272-cGAMP catalog. #tlrl-nacga22
• PBMC peripheral blood mononuclear cell
• interferon-alpha interferon-alpha
• INF- ⁇ interferon-gamma
• TNF- ⁇ tumor necrosis factor-alpha

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